Pretreatment Service Request

3780 South 1550 West St. George, Utah 84790
Phone: (435) 627-4266 Fax (435) 634-5846
Pretreatment Service Request

*Please allow up to 48-hours for review during regular business days, and up to 72-hours if submitting during weekends or holidays.
Date

Month Day Year
Date
Requesting Agency

Ivins Santa Clara St. George Washington Business Other
Request Location Information:
Business Name *
Type of Business *
Business Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date & Time Services are being requested:

*Note: Please select different dates for each choice below. (One choice per day.) Once the request has been received a Pretreatment representative will reply via email with a confirmed date and time.
(1st choice) *

Month Day Year
Date Hour Minutes AM/PM Option
(2nd choice) *

Month Day Year
Date Hour Minutes AM/PM Option
(3rd choice) *

Month Day Year
Date Hour Minutes AM/PM Option
Contact Name *

First Name Last Name
Contact Title *
Phone Number *

Area Code Phone Number
Contact Email Address *
example@example.com
Requestor Information:
Name *

First Name Last Name
Requestor Title *
Phone Number *

Area Code Phone Number
Requestor Email Address *
example@example.com
Reason for Request

Dye Test *All kitchen fixtures need to be installed, in place and pressurized water available before the dye test can be performed. At anytime during the dye test should one or more of the applicable fixtures (i.e. 3-compartment sink, mop sink, etc.) not pass, the dye test will need to be rescheduled. A rescheduled dye test may take up to 14 days depending on staff availability. Grease Interceptor Inspection Grease Trap Inspection Sand/Oil Interceptor Inspection Other
SGRWRF Pretreatment Department Use Only
Is the facility in compliance:

Yes No
Follow-Up action required:

Yes No
Findings and/or follow-up action required:
Inspector:
Date

Month Day Year
Date
Should be Empty:

Pretreatment Service Request

Request Location Information:

Date & Time Services are being requested:

Requestor Information: