2. Please complete the questionnaire below. Contact iwpp@charlestoncpw.com with questions or concerns.
4. Facility/location information
6. Address of discharge
7. Owner
8. Mailing address (if different from discharge address)
10. Primary Contact
11. Phone
12. Email
14. Briefly describe all commercial activities at the site. Include products manufactured or services performed.
15. What SIC/NAICS does your facility report as?
17. Water and wastewater information

    Please list all uses of water at your facility, and estimated average daily volume used and discharged to sewer.

19. Water use by process
20. Average daily volume (gallons/day)
22. Water use by process
23. Average daily volume (gallons/day)
25. Water use by process
26. Average daily volume (gallons/day)
28. Do you operate any of the following processes or activities at your facility?

    1. Alcohol Production
    2. Aluminum Forming
    3. Asphalt Manufacturing
    4. Battery Manufacturing
    5. Beverage Bottling
    6. Canning Foods
    7. Carbon Black Manufacturing
    8. Cement Manufacturing
    9. Coil Coating
    10. Copper Forming
    11. Dairy Products Processing
    12. Electronic Components Manufacturing
    13. Electroplating
    14. Explosives Manufacturing
    15. Feedlots
    16. Ferro Alloy Manufacturing
    17. Fertilizer Manufacturing
    18. Foundries: Metal Mold & Casting
    19. Glass Manufacturing
    20. Grain Mills
    21. Gum & Wood Chemicals Manufacturing
    22. Ink Formulating
    23. Inorganic Chemical Manufacturing
    24. Laundry
    25. Leather Tanning & Finishing

    1. Meat Processing
    2. Medical Care Operations
    3. Metal Finishing
    4. Metal Molding & Casting
    5. Mineral & Ore Processing
    6. Nonferrous Metal, Form & Powders
    7. Nonferrous Metals Manufacturing
    8. OCPSF, Organic Chemicals, Plastics, and Synthetic Fiber Manufacturing
    9. Oil & Gas Extraction
    10. Paint Formulating
    11. Roofing Materials Manufacturing
    12. Petroleum Refining
    13. Pharmaceutical Manufacturing
    14. Phosphate Manufacturing
    15. Photographic Developing
    16. Plastic Injection Molding & Forming
    17. Porcelain Enameling
    18. Printing & Publishing
    19. Rendering
    20. Rubber Manufacturing
    21. Soap & Detergent Manufacturing
    22. Textile Mills
    23. Timber Products Processing
    24. Other (list below)
30. If you selected other, please list here.
32. Do you use well water?

    1. Yes
    2. No
33. Do you have a groundwater remediation system?

    1. Yes
    2. No
34. Is rainwater collected and used at your facility?

    1. Yes
    2. No
36. By checking this box, I certify that there is no stormwater entering the sanitary sewer system at this site.
38. Please sign/write your name and put today's date if you certify that all of the information on this form is true and accurate to the best of your knowledge.*
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field