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Commercial Wastewater Discharge Permit Application (CWDP)
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CITY OF MILTON
Commercial Wastewater Discharge Permit (CWDP) Application
Section I. - General Information
Establishment Physical Address
Billing Address (If different from above) DO NOT USE P.O. BOX
Website or Email Address
Section II. - Facility Operation Characteristics
Please choose a description from the list below that best describes the facility:
Assisted Living Facility
Automotive Repair Garage
Drive Through (only) Restaurant
Fast Food Restaurant
Full Service Restaurant
Gasoline Station w/ Grease Rack
Ice Cream Shop
Vehicle and Equipment Wash
Please indicate each item currently connected to the City's Wastewater Facility presntly in the establishment:
2 Bay/Pre Rinse Sink
3 Bay Sink
Hand Wash/Single Bay Sink
Tilt Kettle/Crock Pot
Indicate the seating capacity of the establishment, if applicable
Indicate days and hours of operation:
Section III. - Pretreatment Device
Indicate the type of pretreatment device(s) currently in operation at the above facility address:
Indoor/Internal Grease Trap
Outdoor/External Grease Interceptor
None of the Above
If there are multiple pretreatment devices available, indicate how many:
Please provide the Grease Trap, Grease Interceptor, or Oil/Water Separator specifications below:
Internal Dimensions or Total Volume:
Manufacturer Data (if known):
Model Number(s) (if known):
Are there any additives placed into the plumbing facilities or pretreatment device (i.e., enzymes, bacteria, etc.)?
If the answer to the above was in the affirmative, please provide the following information:
Upload (if available) the MSDS for the product(s) used
Location where added to the system:
The frequency at which the additive is applied
Section IV. - Renewal Facility Information
Have there been any changes, expansions, or modifications to the above establishment's pretreatment device since the issue date of the establishment's last Commercial Wastewater Discharge Permit?
If the answer to the above question was in the affirmative, please indicate below the extent of the change, expansion, or modification:
Have there been any changes, expansions, or modifications to the above establishment's physical characteristics, including but not limited to the kitchen, seating capacity, plumbing, and general strucutre since the issue date of the establishment's last Commercial Wastewater Discharge Permit?:
If the answer to the above was in the affirmative, please indicate below the extent of the change, expansion, or modification that has occurred:
Section V. - Disposal (Applicable to Grease Interceptors and Oil/Water Separators)
Provide the name of the contracted Florida Licensed Grease Waste Hauler that collects, removes, and disposes of the fats, oils, and grease material produced at the above establishment:
Provide the telephone number of the contracted Florida Licensed Grease Waste Hauler that collects, removes, and disposes of the fats, oils, and grease material produced at the above establishment:
Does the above establishment recycle any used fryer/yellow/tallow oil or grease produced on site?
If the answer to the above was in the affirmative, please provide the name of the Florida Licensed Grease Waste Hauler which collects, removes, and disposes of the fats, oils, and grease produced at the above establishment:
If the answer to the above was in the affirmative, please provide the telephone number of the Florida Licensed Grease Waste Hauler which collects, removes, and disposes of the fats, oils, and grease produced at the above establishment:
Section VI. - Authorized Signature
I certify the I understand that pursuant to Article V. Division 5. of the Chapter 48, The City of Milton, Fats, Oils, and Grease Management Program, of the CIty of Milton Code of Ordinances, that all food service establishments and automotive related enterprises must have installed a fats, oils, and grease pretreatment/removal device prior to discharging into the CIty's Wastewater Treatment System/Sanitary Sewer System. I further certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personne gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware there are significant penalties for submitting false or misleading information, including but not limited to the possibility of fine and imprisonment.
STOP - BELOW IS FOR CITY USE ONLY
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