City of Dayton Industrial Pretreatment Program FORMS

• This form should be filled out by all users that propose to discharge anything other than domestic wastewater to the sanitary sewer.

Industrial User Survey (.PDF / .DOC)

• This form may be required to be filled out periodically by users of the sanitary sewer system.

Baseline Report (.PDF / .DOC)

• This form is required to be filled prior to the discharge of categorical wastewater.

Ninety Day Report (.PDF / .DOC)

• This form is required to be filled out by all users regulated under categorical standards with a new Industrial Wastewater Discharge Permit.

Periodic Report on Continued Compliance (basic) ( .DOC)

• Instructions for filling out the form: (.PDF / .DOC)
• Log of Additional Self-Monitoring (.XLS)
• This form is for all Significant Industrial Users with an Industrial Wastewater Discharge Permit. This form should be filled out in accordance with the frequency defined in the Industrial Wastewater Discharge Permit.

Periodic Report on Continued Compliance (Zero Discharge) ( .DOC)

• Instructions for filling out the form: (.PDF / .DOC)
• This form is for all Significant Industrial Users with an Industrial Wastewater Zero Discharge Permit. This form is basically is a certification by the authorized representative that no categorical wastestreams were discharged during the applicable period. The applicable period should be specified in the comments section of the form (i.e. October 1 – December 31, 2006), but it should not be for greater than one calendar quarter.

Slug Plan (.PDF / .DOC)

• This form is required to be filled out on a case-by-case basis.

Toxic Organic Management Plan (.PDF / .DOC)

• Instructions for filling out the form: (.PDF / .DOC)
• This form is required to be filled out by all users regulated under Electroplating, Metal Finishing,  Electrical and Electronic Components Categories, or other categories containing a TTO limit in the Industrial Pretreatment Program.

Pretreatment Review Form (.PDF / .DOC)

• This form is for new businesses