Wastewater Discharge Application

2176 W. Treatment Plant Rd., St. George, Utah 84790
Phone: (435) 627-4266 Fax (435) 634-5846
Wastewater Discharge Application - Food Trucks

(Source Control Program)
Application Date

MonthDayYear
Date
Name of Food Truck *
Was this Food Truck purchased from another business?*

YesNo
*If yes, provide the name of the former Food Truck business.
Address where Food Truck will be located (If more than one location, please complete section D)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person*
Phone Number*

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

Area CodePhone 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?

YesNo
Cooked?

YesNo
Heated?

YesNo
C: The dishes here are:
Washed and reused?

YesNo
Disposable?

YesNo
F: Operating hours of business
G: Days of Operation

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
H: What meals do you primarily serve? (Check ALL that apply)
BreakfastLunchDinnerDessert
B. Fixtures Present
Deep Fryer

YesNo
Dishwasher

YesNo
Grill

YesNo
Grill Hood

YesNo
Oven

YesNo
Mop Sink

YesNo
Microwave

YesNo
Convection Oven

YesNo
Sink - 1 bay

YesNo
Sink - 2 bay

YesNo
Sink - 3 bay

YesNo
Hand Washing Sink

YesNo
Pre-rinse Sink (ware washing)

YesNo
Prep Sink (prepping & washing food)

YesNo
Wok/Tilt Kettle

YesNo
Broiler

YesNo
Stove

YesNo
(If stove is Yes, provide the number of burners)
C. Source Control Present
Do you have a grease trap installed?

YesNo
Is the grease trap operational?

YesNo
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?

YesNo
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 NameLast 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:

YesNo
Follow-Up action required:

YesNo
If follow-up required, explain:
Inspector:
Date

MonthDayYear
Date
Should be Empty:

Wastewater Discharge Application - Food Trucks

A. General Information

B. Fixtures Present

C. Source Control Present

D. Additional Locations:

E. Signatory Requirement: