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Landowner or Lessee
Wastewater producing operations at this site is:
Months of Operation
Day of Week discharge will occur
Site have EPA generator number?
Environmental Control Permits
Written Spill prevention prepared?
Water supplied by Landlord
Site Exposed to rainwater/stormwater runoff connected to sewerage?
Site Wastewater Contitutions
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Pretreatment performed or planned?
Type of Pretreatment Used or Planned
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Wastes Recycled/Removed from Site
Recycled on site?
Removed from the Site
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05/25/2026Click to Sign
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