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City of Dayton
Industrial Pretreatment Program
FORMS
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 Application for Industrial
Wastewater Service (.PDF
/ .DOC)
- 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
Back to the Industrial Pretreatment Home Page.
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