Pretreatment Questionnaire

Business Name*

Business Address (Location in Spanish Fork/Mapleton where work will be performed)*

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

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?*

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

Kitchen Fixtures*

	Number of Fixtures
3-Compartment Sink
Hand Sink
Dishwasher
Floor Drains
Garbage Disposal
Bar Sink
Mop Sink

How are food byproducts disposed of?*

	Sewer	Trash	Recycle
Solid Wastes
Oil and Grease
Liquid Waste

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

Which of the following kitchen fixtures are connected to your grease interceptor or trap?*


3-Compartment Sink
Hand Sink
Dishwasher
Floor Drains
Garbage Disposal
Bar Sink
Mop Sink

Describe Your Business (Put 'Shell Building Only', if the location is unoccupied)*

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*

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Spanish Fork City Pretreatment Questionnaire

Wastewater