Directions for Completing Commercial/Industrial - Pretreatment Survey
1. Business Name: This is the name of business.
2. Facility Address: The physical address of the facility.
3. Mailing/Billing Address: Mailing address of the facility.
4.
Contact Person and Telephone Number: The facility contact and telephone number.
5. Facility Telephone Number: The telephone number of the facility.
6. Email Address: The email address of the contact person.
7. Title: Title of contact person.
8. Nature of business: Short detail of type of business.
9. Number of Employees: List number of Full-time and Part-time employees.
10. Normal Operation Hours: The hours the facility is open.
11. Nature of Discharge: Check the appropriate box that best describes the type of wastewater
that the facility will discharge into the City of Sumner sewer system.
12.
Wastewater Pretreatment: Indicate the type of treatment for process waste generated at
facility.
13.
Water Balance: Please provide approximation of total water used for sanitary and production
needs.
14. Raw Materials and Chemicals used in process: list all chemicals used in production process.
15. Common priority pollutants in discharge: If know, indicate which priority pollutants may be present
in process wastewater discharge. Include analysis report if available.
16. Certification Statement: Sign the certification statement.
If you have questions or need assistance, please contact Andria Swann,
City of Sumner Pretreatment Coordinator, at 253-299-5713, or at andrias@sumnerwa.gov.
