Commercial Waste Discharge Permit Application

Permit Information

Is this application for a New or Existing Permit (Renewal)?

New

Facility Information

Name of Facility	Facility Name
Facility Contact Name	Facility Contact Name
Facility Contact Phone Number	+18009999999
Facility Physical Address	900 Baseline Rd, Boulder CO 80302-7547
Facility Contact Email Address	[email protected]
Is Facility Mailing Address the same as above?	Yes

Owner / Corporate Information

Owner / Corporation Name	Owner Corp Name
Owner Contact Name	Owner Contact Name
Owner Contact Telephone	---
Owner Address	---

Commercial Waste Pretreatment System - Subsurface, exterior system

Do you have a Subsurface, exterior system?

Yes

Exterior Tank #1

Trap #1 Type	Grease Trap
Tank #1 Capacity	3000
Do you have a second Subsurface, exterior system?	No

Commerical Waste Pretreatment System - Interior System

Do you have an interior PT system?

No

Type of Business

Type of Business (restaurant, school, car maintenance)	Auto Repair
Has new equipment been added since business opened?	No
Are your water and sewer provided by same jurisdiction?	Yes, same jurisdiction

Utilities Jurisdiction

Water & Sewer Jurisdiction

jurisdiction

Commercial Waste Transporter Service (Pumper)

Company Name	Pumper co name
F.O.G. Permit Number	1234
Company Contact Name	Pumper contact name
Company Address	900 Baseline Rd, Boulder CO 80302-7547
Company Telephone Number	+18009999999

Waste Removal

Do you use a Grease/Waste Oil Recycle Company?

No