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Sanitary Sewer - Industrial User Survey
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Steps
1.
General Information
This section is complete
This section is incomplete
2.
Description of Operation
This section is complete
This section is incomplete
3.
Usage Information
This section is complete
This section is incomplete
4.
Wastewater Characteristics
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5.
Industry Characteristics
This section is complete
This section is incomplete
6.
Pretreatment Devices
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7.
Medical/Dental Facilities
This section is complete
This section is incomplete
8.
Automative Facilities
This section is complete
This section is incomplete
9.
Vehicle Washes
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10.
Comments & Attachments
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This section is incomplete
General Information
Pretreatment Program -
Sanitary Sewer User Survey
The City of Kennewick is in the process of becoming “Fully Delegated,” which simplified, is the transfer of authority from the Department of Ecology to the City of Kennewick. With this delegation of authority, the City will be responsible for developing Wastewater Discharge Permits for its users. A significant step in this process is the requirement of conducting an Industrial User Survey. The required survey will allow the City to gather information on wastewater discharged by our sanitary sewer system users. The information collected is designed to identify discharges that could be harmful to the city’s infrastructure, treatment plant, and everyone’s aquatic environment. The City is responsible for collecting this information from all non-residential customers and submitting the information to the Department of Ecology to ensure that proper controls are in order for significant sources of potential contaminants.
Please fill out sections 1-6 and all other sections that pertain to your facility. Any questions regarding the survey, please contact Gina Morgan at (509) 585-4483.
1. GENERAL INFORMATION
Company Name:
*
Business Mailing Address:
*
City:
*
State:
*
Zip:
*
Facility Address:
*
City:
State:
Zip:
*
Facility Contact Name:
*
Telephone Number:
*
Email:
Continue
Description of Operation
2. DESCRIPTION OF OPERATION
Products or Service Produced at Facility:
Describe the manufacturing process or services conducted on the premises (include any activities where wastewater is produced):
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Usage Information
3. WATER USE AND WASTEWATER DISCHARGE
Please Indicate the Purposes for Water Usage at your Facility:
Estimated Gallons Per Day:
Domestic waste (restrooms, employee showers, handwashing)
*
Yes
No
Gallons
Non-Contact Cooling Water
*
Yes
No
Gallons
Contact Cooling Water
*
Yes
No
Gallons
Equipment Washing/Rinsing
*
Yes
No
Gallons
Boiler Blowdown
*
Yes
No
Gallons
Process Water
*
Yes
No
Gallons
Other: (describe)
Gallons
Total Volume (Gallons) Discharged to Sanitary Sewer:
Is 100% of the wastewater discharged to the Sanitary Sewer System domestic waste (Restrooms, handwashing, showers ONLY)
Yes
No
Is 100% of wastewater discharged to the Sanitary Sewer System?
Yes
No
If NO, please indicate other ways wastewater is discharged:
Flow to ground (drainfield, wetwell)
*
Yes
No
Gallons/day:
Storm Sewer (non-contact cooling water)
*
Yes
No
Gallons/Day:
Pick-up by Waste Hauler/Recycler
*
Yes
No
Gallons/Day:
Other: (describe)
Gallons/Day:
Is there a spill prevention plan prepared for this facility?
Yes
No
If Yes, please describe:
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Wastewater Characteristics
4. WASTEWATER CHARACTERISTICS
Please check the box(es) next to the substances potentially present in your wastewater:
Acids/acidic waste
Soaps and detergents
Inks/dyes/pigments
Benzene
Paints
Waxes
Hot wastes, temp:
Alcohols
Solvents/thinners
Latex wastes
Alkali and caustic wastes
Fats/oils/grease
Chlorinated compounds
Brominated compounds
Plating wastes
Resins
Ethers
Aldehydes, ketones
Powdercoating/electrocoating wastes
Phenol containing wastes
Metals:
Copper
Cadmium
Mercury
Zinc
Nickel
Other Metals (describe):
Other substances (describe/list):
pH of wastewater:
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Industry Characteristics
5. INDUSTRY CHARACTERISTICS
Industry Category
Adhesives
Aluminum forming
Auto washing
Auto repair/body work
Battery manufacturing
Beverage bottling
Can making
Coil coating
Copper forming
Dental
Electric and electronic components manufacturing
Electroplating
Food Manufacturing
Hospitals
Inorganic chemicals
Iron and steel
Leather tanning/finishing
Metal finishing
Metal molding and casting
Organic chemicals manufacturing
Painting
Pesticide manufacturing
Pharmaceutical
Photo/film processing
Plastic and synthetic material manufacturing
Porcelain
Printing and publishing
Pulp/paper manufacturing
Slaughter/meat packing
Soap and detergent manufacturing
Stone cutting
Wood products
Other (describe):
Number of employees:
Hours/day
Normal Operating Schedule
Days/week
Normal Operating Schedule
Production Type:
Batch (product or material is produced in stages)
Continuous (non-stop process)
Both
Percentage for Batch Production:
Percentage for Continuous Production:
Is product subject to seasonal variation?
Yes
No
If YES, describe the seasonal production cycle including the months of highest and lowest production:
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Pretreatment Devices
6. PRETREATMENT DEVICES AND PROCESSES
Pretreatment refers to elimination or reduction in pollutants being discharged to the sewer system through physical, chemical, or biological means.
Please check all methods of pretreatment for this facility:
Physical Pretreatment:
Amalgam separator
Clarifiers
Evaporation
Filtration
Grease trap (provide size below)
Grit removal
Oil/water separator
Reverse osmosis
Screening
Sedimentation
Silver recovery
Spill protection
Other Physical Pretreatment Methods:
Describe physical pretreatment methods used other than the ones checked on the left.
Grease trap size:
Chemical Pretreatment:
Carbon filter
Chemical precipitation
Chlorination
Ion exchange
pH neutralization
Other Chemical Pretreatment Methods:
Describe chemical pretreatment methods used other than the ones checked on the left.
Biological Pretreatment:
Describe the type of biological treatment(s) used.
Provide a description of any pretreatment systems:
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Medical/Dental Facilities
7. MEDICAL / DENTAL FACILITIES
Type of Facility:
Chemotherapy
Dialysis
Dental
General practioner
Hospital
Laboratory
Pharmacy
Radiology
Research and development
Veterinary
Other:
Equipment Used at Facility:
Autoclave
CT scan
Fluoroscopy
Laundry
MRI
Photo development
Sterilizer
X-Ray, digital
X-Ray, film
Other:
If the X-Ray film box is checked above, answer the next two questions.
1) Where do you dispose of fixer waste:
2) How much fixer waste is disposed of per year?
Medicines / Medications / Prescriptions:
How are unused, expired, or discontinued medications disposed of? Check all that apply.
Garbage (solid waste)
Incinerated offsite
Toilet or drain
Incinerated onsite
Do you generate any of the following hazardous substances or dangerous wastes? Check all that apply and state how it is disposed of below:
Acetone
Acids
Alcohols
Amalgam
Caustics
Developer
Disinfectants
Dyes
Ethanol
Ethers
Formaldehyde
Freon
Germicides/sterilants
Heavy metals
Hexane
Mercury-containing devices
Methylene chloride
Silver/fixer
Solvents
Stains
Toluene
Trichloroethylene
Trichloromethane
Xylene
Other:
List hazardous substance/dangerous waste that was checked above and describe how it is disposed of:
List any permits issued by the Health Department, Department of Ecology, EPA or Fire Department:
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Automative Facilities
8. AUTOMOTIVE FACILITIES
Type of Facility:
Automotive detailing
Automotive glass replacement
Automotive repair (engine, muffler, radiator, etc.)
Body repair
Car wash: if checked, complete Section 9 below
Dealership/sales
Oil & filter change
Paint
Tire sales
Other:
General Information:
How many service bays do you have?
Does your facility have an on-site above ground storage tank?
Yes
No
If YES, complete the following for each tank:
Capacity:
Contents:
Date last cleaned/emptied:
Capacity:
Contents:
Date last cleaned/emptied:
Capacity:
Contents:
Date last cleaned/emptied:
Capacity:
Contents:
Date last cleaned/emptied:
Capacity:
Contents:
Date last cleaned/emptied:
Does your facility have an on-site underground storage tank?
Yes
No
If YES, complete for each tank:
Capacity:
Contents:
Date last cleaned/emptied:
Capacity:
Contents:
Date last cleaned/emptied:
Capacity:
Contents:
Date last cleaned/emptied:
Capacity:
Contents:
Date last cleaned/emptied:
Capacity:
Contents:
Date last cleaned/emptied:
Does your facility have any floor drains?
Yes
No
How many floor drains and where are they located?
Does your facility have an on-site storm water catch basin?
Yes
No
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Vehicle Washes
9. VEHICLE WASH
General Information:
Do you have an automated car wash?
Yes
No
How many wash bays do you have?
Average number of vehicles washed:
Per Day:
Per Month:
Do you recycle your wash water?
Yes
No
List the type and quantity of agents used to wash vehicles:
DETERGENTS:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
SOLVENTS:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
DEGREASERS:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
Name of Product:
Monthly average quantity stored on-site:
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Comments & Attachments
10. ADDITIONAL COMMENTS
Please provide any additional comments or information not addressed in this survey or attach comments as necessary.
Upload attachments:
Leave This Blank:
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Email address
This field is not part of the form submission.
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