Pretreatment Questionnaire

Spanish Fork City Pretreatment Questionnaire
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your business operated from your place of residence?*

YesNo
Mailing Address (if different than business address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Wastewater

Wastewater is a composite of everything that enters the sewer system, usually via toilets, sinks, or drains. Process or industrial wastewater is wastewater that has come in contact with any product or part of the production process of a business in any way. A business' public and/or private restrooms are not considered process or industrial wastewater.
Does your business discharge process or industrial wastewater?*

YesNoOnly public and/or private restrooms
Does your business discharge more than 25,000 gallons of process wastewater per day?*

YesNoI don't know
Does your business discharge wastewater or handle chemicals regulated under Categorical Pretreatment Standards found in 40 CFR 405-471?*

YesNoI don't know
Please Specify:*
Does your business involve food preparation?*

YesNo
What type of food preparation?*

BakingGrillingFryingVegetable PrepOther
Approximately how many customers do you serve per average day? *

Do you have a grease interceptor or trap?*
* A grease interceptor is a large underground device designed to remove fat, oil, and grease from your kitchen wastewater. A grease trap is a small, similar device that is located under the sink. These devices are different from your grease recycling bin.
What size (gallons) is the interceptor or trap?*
Is the interceptor or trap functioning properly?*

YesNo
How often is the interceptor or trap serviced?*
When was the trap or interceptor last serviced?*
If known, what is the average volume of waste removed from the interceptor or trap when it is serviced?*
Company that services the interceptor or trap*
Company Name
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Area CodePhone Number
Are service receipts available?*

YesNo
Are cleaning / maintenance logs available?*

YesNo

Describe Your Business*
Describe the Wastewater Production of Your Business*
Additional Comments / Information
Hazardous Waste

Hazardous Waste, as defined by 40 CFR 261, is prohibited from being discharged to the sewer, storm drains and waterways. For information on disposal please visit the state website:

https://deq.utah.gov/waste-management-and-radiation-control/hazardous-waste-management-program
Signature*

Clear
Should be Empty:

Spanish Fork City Pretreatment Questionnaire