City of Troutdale

Industrial User Wastewater Survey

  • Please answer all questions and use "N/A", if appropriate.
  • Click the "Submit" button when complete, and the City of Troutdale will review your responses.
  • If responses need additional information, clarification, or correction, a member of the Engineering Division will contact you.
  • Once the City of Troutdale has reviewed and finalized your Industrial User Wastewater Survey (IUWS) responses, you will receive a confirmation email with the finalized survey responses attached as a .pdf file. Upon receipt of the confirmation email please perform the following steps:
  1. Open email with .pdf file of the IUWS responses
  2. Print the IUWS and sign Section 4.4 Required Signature. The USEPA requires that local pretreatment programs receive a wet signed copy of survey responses without an approved e-signature CROMERR program.
  3. Mail a hard copy of the IUWS with responses and wet signature to:
  4. City of Troutdale Department of Public Works Attn: Environmental Specialist 342 SW 4th Street Troutdale, OR 97060
  5. After the IUWS hard copy has been received and verified complete with signature, the IUWS will be approved by the City of Troutdale.
 

Section 1.0 General Information

 
 
 
 
 

If different from Business Street Address

 

Primary contact for information submitted in IUWS

 
 
Phone
 
 
 
  • National Pollutant Discharge Elimination System (NPDES)
  • If applicable
 
 
 
 
 

 

Section 2.0 Business Wastewater Information

 

Domestic wastewater is from fixtures typically found in a residential home such as toilets, showers, non-commercial sinks and gray water from consumer-grade dishwashers and washing machines. Process wastewater includes industrial and commercial generated wastewater other than domestic waste as well as wastewater generated from a professional commercial kitchen.

 

 

Section 3.0 Fats, Oil, and Grease

If the Building or Plumbing Official has determined a GRD is required or there is an existing GRD, please fill out Section 3.0. Businesses are encouraged (but not required) to utilize vendors on the regional Preferred Pumpers list for maintenance and servicing of their grease removal devices (GRD). The Preferred Pumpers list is available here along with their cleaning and inspection standards.

 

 

Section 4.0 Business Chemical Information

 

Not including common household chemicals or non-industrial chemicals applied in quantities typical of household use

 

 

Section 5.0 Authorized Representative Certification

 
 
 
  1. If the industrial user is a corporation:
  2. The president, secretary, treasurer, or a vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy or decision-making functions for the corporation; or
  3. The manager of one or more manufacturing, production, or operation facilities provided, the manager is authorized to make management decisions which govern the operation of the regulated facility including having the explicit or implicit duty of making major capital investment recommendations, and initiate and direct other comprehensive measures to assure long-term environmental compliance with environmental laws and regulations; can ensure that the necessary systems are established or actions taken to gather complete and accurate information for control mechanism requirements; and where authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures.
  4. If the user is a partnership or sole proprietorship: a general partner or proprietor, respectively.
  5. If the user is a federal, state, or local governmental facility: a director or highest official appointed or designated to oversee the operation and performance of the activities of the government facility, or their designee.
  6. The individuals described in subsections 1 through 3, above, may designate another authorized representative if the authorization is in writing by the individual described in subsections 1 through 3 above, the authorization specifies the individual or position responsible for the overall operation of the facility from which the discharge originates or having overall responsibility for environmental matters for the company, and the written authorization is submitted to the city.
 
 

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