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Industrial Wastewater Screening Questionnaire

  1. Please complete the questionnaire below. Contact with questions or concerns.
  2. Facility/location information
  3. Water and wastewater information

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

  4. Do you operate any of the following processes or activities at your facility?
  5. Do you use well water?
  6. Do you have a groundwater remediation system?
  7. Is rainwater collected and used at your facility?
  8. By checking this box, I certify that there is no stormwater entering the sanitary sewer system at this site.
  9. Leave This Blank:

  10. This field is not part of the form submission.