Fillable FULTON COUNTY WASTEWATER DISCHARGE SURVEY (Fulton County Government)

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FULTON COUNTY WASTEWATER DISCHARGE SURVEY (Fulton County Government)

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The FULTON COUNTY WASTEWATER DISCHARGE SURVEY (Fulton County Government) form is 2 pages long and contains:

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  • 21 check-boxes
  • 15 other fields

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Initial Wastewater survey form Page 1
Project Name: __________________________________________________________________
Project Location: _______________________________________________________________
Type of business (check all that apply) that will be conducted at the facility discharging into
the Fulton County wastewater collection system:
□ General Office/Retail
□ Medical Office
□ Hospital
□ Biogenetic Laboratory
□ Car Wash
□ Chemical Storage & Sale
□ Laundromat /
Drycleaner
□ CLF (Congregate Living Facility
□ Food Preparation and Processing:
□ Funeral Home
□ Medical Waste Storage & Processing
□ Automotive Repair Shop
□ Fuel Storage
□ Photo Development
□ Others (Specify) _______________________________________
Name of Property:________________________________________________________________
Owner/Developer/Authorized Agent:________________________________________________
Address:________________________________________________________________________
_______________________________________________________________________________
Telephone Number:______________________________________________________________
Projected Connection Date: ________________________________________________________
FULTON
COUNTY
WASTEWATER DISCHARGE SURVEY
Industrial Monitoring
7472 Cochran Road,
College Park, GA 30349
404-612-0212
Initial Wastewater survey form
Page 2
What type of process (es)
will generate wastewater other than Domestic Waste?
Describe any pretreatment methods and facilities employed. Check all that apply:
□ Oil/Grease Interceptor
□ Grease Trap
□ Sand oil Interceptor □ Neutralization process
□ Storage and Offsite Disposal without discharge to the Fulton County Wastewater Collection
System
□ Other (specify):
I herein certify that the information submitted is to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false
information.
SIGNATURE: ____________________________________________________________
DATE: ____________________
List all chemicals/pollutants other than Domestic Waste that might be present in your
proposed discharge:
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FULTON COUNTY WASTEWATER DISCHARGE SURVEY (Fulton County Government)

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Completed 6 August 2020

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