Wastewater Discharge Application

3780 South 1550 West St. George, Utah 84790
Phone: (435) 627-4266 Fax (435) 634-5846
Wastewater Discharge Application - Food Trucks

(Source Control Program)
Application Date

Month Day Year
Date
Name of Food Truck *
Address where Food Truck will be located (If more than one location, please complete section D) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact Person *
Phone Number *

Area Code Phone Number
Contact Email Address *
example@example.com
Owner *
Phone Number *

Area Code Phone Number
A. General Information

Answer ALL questions as completely as possible.
A. What type of food is served?
B. On site, most of the food is:
Prepared?

Yes No
Cooked?

Yes No
Heated?

Yes No
C: The dishes here are:
Washed and reused?

Yes No
Disposable?

Yes No
E: Number of meals served per week
F: Operating hours of business
G: Days of Operation

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
H: What meals do you primarily serve? (Check ALL that apply)
Breakfast Lunch Dinner Dessert
B. Fixtures to be Present
Deep Fryer

Yes No
Dishwasher

Yes No
Grill

Yes No
Grill Hood

Yes No
Oven

Yes No
Mop Sink

Yes No
Microwave

Yes No
Convection Oven

Yes No
Sink - 1 bay

Yes No
Sink - 2 bay

Yes No
Sink - 3 bay

Yes No
Pre-rinse Sink

Yes No
Wok/Tilt Kettle

Yes No
Broiler

Yes No
Stove

Yes No
(If stove is Yes, provide the number of burners)
C. Source Control Present
Do you have a grease trap installed?

Yes No
Is the grease trap operational?

Yes No
Size of the grease trap?
Location of the grease trap?
Who will be cleaning out your grease trap?
How often will the grease trap be cleaned out?
Do you have a Commissary Agreement?

Yes No
If you have a Commissary Agreement, who is it with? (Name and location)
*A copy of the Commissary Agreement will need to be provided to the Pretreatment Department.
Where will you be disposing of your wastewater?
*Note: Any wastewater/grey water disposed of at any location other that the SGRWRF or an approved Commissary is prohibited.
D. Additional Locations:
Location #1
Location #2
Location #3
Location #4
E. Signatory Requirement:
Application completed by:
Name

First Name Last Name
Title
Signature

Clear
*Please allow up to 48-hours for review during regular business days, and up to 72-hours if submitting during weekends or holidays.
SGRWRF Pretreatment Department Use Only
Is the facility in compliance with the source control program:

Yes No
Follow-Up action required:

Yes No
If follow-up required, explain:
Inspector:
Date

Month Day Year
Date
Should be Empty:

Wastewater Discharge Application - Food Trucks

A. General Information

B. Fixtures to be Present

C. Source Control Present

D. Additional Locations:

E. Signatory Requirement: