1
City of Bethlehem
Wastewater Treatment Plant Industrial Pretreatment Program
Preliminary Application for Industrial Wastewater Discharge Permit
All non-residential establishments proposing to discharge to the sanitary sewer system
must complete this form. The information submitted will be used to determine the need
to apply for an industrial waste discharge permit. Please return to:
Christian Torres
City of Bethlehem
Wastewater Treatment Plant
144 Shimersville Road
Bethlehem, PA 18015
1. Contact Information
Facility or Business Name
Mailing Address
Facility Location
Contact Person & Title
Telephone Number
Fax Number
Email Address
2. Standard Industrial Classification (SIC) Code(s)
North American Industry Classification System (NAICS) Code(s)
3. Average daily volume (gallons) of wastewater discharged.
Process
Non-contact cooling
Sanitary
Other (describe)
4. Describe each process that produces waste. Include the year in which discharge of each
process began. Attach additional sheets if necessary.
5. List all raw materials, process additives, cleaning materials, byproducts, etc. used or
generated at this facility. Attach additional sheets if necessary.
2
6. Describe any spill prevention and containment measures that are in place both inside and
outside this facility that may prevent any slug discharge releases into the sanitary or
stormwater sewer system. Attach additional sheets if necessary.
7. Describe the location of any sanitary sewer cleanouts, grease interceptors, and private
sanitary sewer manholes at the facility. Attach additional sheets and diagrams if necessary.
8. If any analysis has been performed on the wastewater discharge from the facility, please
attach a copy of the most recent laboratory report to this application.
9. Does this facility perform any operations which could be included in the following industrial
categories? Check all that apply.
Airport Deicing 449
Leather Tanning and Finishing 425
Aluminum Forming 467
Meat and Poultry Products 432
Asbestos Manufacturing 427
Metal Finishing 433
Battery Manufacturing 461
Metal Molding and Casting 464
Canned and Preserved Fruits and Vegetables Processing 407
Metal Products and Machinery 438
Canned and Preserved Sea Food Processing 408
Mineral Mining and Processing 436
Carbon Black Manufacturing 458
Nonferrous Metals Forming and Metals Powders 471
Cement Manufacturing 411
Nonferrous Metals Manufacturing 421
Centralized Waste Treatment 437
Oil and Gas Extraction 435
Coal Mining 434
Ore Mining and Dressing 440
Coil Coating 465
Organic Chemicals, Plastics, and Synthetic Fibers 414
Concentrated Animal Feeding Operations 412
Paint Formulating 446
Concentrated Aquatic Animal Production 451
Paving and Roofing Materials 443
Construction and Development 450
Pesticide Chemicals 455
Copper Forming 468
Petroleum Refining 419
Dairy Products Processing 405
Pharmaceutical Manufacturing 439
Electrical and Electronic Components 469
Phosphate Manufacturing 422
Electroplating 413
Photographic 459
Explosives Manufacturing 457
Plastics Molding and Forming 463
Ferroalloy Manufacturing 424
Porcelain Enameling 466
Fertilizer Manufacturing 418
Pulp, Paper, and Paperboard 430
Glass Manufacturing 426
Rubber Manufacturing 428
Grain Mills 406
Soap and Detergent Manufacturing 417
Gum and Wood Chemicals Manufacturing 454
Steam Electric Power Generating 423
Hospital 460
Sugar Processing 409
Ink Formulating 447
Textile Mills 410
Inorganic Chemicals Manufacturing 415
Timber Products Processing 429
Iron and Steel Manufacturing 420
Transportation Equipment Cleaning 442
Landfills 445
Waste Combustors 444
Name
Title
Signature
Date
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome