WPCP Industrial Waste and Sewer Use Evaluation

 Step 1 of 1

The City of Davenport is required to identify and locate all possible Industrial Wastewater System Users that may be subject to the City’s Pretreatment Program, to identify the character and volume of pollutants in industrial user wastewater discharge, and to update the pretreatment program list at least yearly per federal, state, and local regulation. The objective of this survey is to determine whether your facility may be subject to the requirements of the City of Davenport’s Pretreatment Program. Requests for confidential treatment of information provided on this form shall be governed by procedures specified in the provisions of 561-2 of the Iowa Administrative Code. In accordance with Title 40 of the Code of Federal Regulations Part 403, Section 403.14 and the local Sewer Use Ordinance, information and data provided in this form which identifies the content, volume, and frequency of discharge shall be available to the public without restrictions.

  • Consider printing this form to collect your data before completing this form.  The survey cannot be saved and returned to. 

If you have questions please call the Davenport Water Pollution Control Plant (WPCP) Lab at 563.326.7877.

* Denotes a required field

Section 1 - Facility Location and Contacts

*
*
*
*
*
*
*
*
*
*

Section 1A - Primary and Secondary Contacts. Name of primary and secondary responsible person onsite at the facility authorized to represent the company in official dealings with the Pretreatment Office and/or the City of Davenport.

*
*
*
*
*
*
*

Section 1B - This statement is to be signed by an authorized official of your firm, as defined in the local Sewer Use Ordinance or the Federal Regulations; 40 CFR 403.12 (l), after completion of this form.

I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based upon my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and/or imprisonment for knowing violations.
*
*
*
*

Section 2 - General Facility Information

*
*
Type of Spaces in Facility (Check all that apply)*
Human Occupancy. The occupants of the facility are predominantly*
*
*
*
*

Section 2A - Incoming water and its use.

Process Water. Indicate source, metering and measurement information by selecting all that apply.*
*
 
*

Section 3 - Chemical Storage and Spill Prevention

Does your facility have any chemical storage containers, bins or ponds?*
If yes, on a separate sheet describe the location(s), content(s), size(s), type(s) and frequency and method of cleaning. Also indicate on a diagram or comment on the proximity of these containers to sewer or storm drain(s). Email to victoria.gleason@davenportiowa.com.
Does your facility have floor drains?*
If your facility has chemical storage container(s), bin(s), or pond(s), could an accidental spill lead to discharge to… (check all that apply)*
*
Is there any waste disposal other than sewer or trash (ie: incineration, used solvents and/or oil pick up)?*
If yes, on a separate sheet describe other disposal methods. Email to victoria.gleason@davenportiowa.com.

Section 4 - Pretreatment Information

Are there any pretreatment device(s) or process(es) used for treating wastewater before being discharged to the sanitary sewer?*
Are there any pretreatment device(s) or process(es) changes planned for this facility within the next three (3) years?*
If you answered yes to either of the above, check all pretreatment device(s) or process(es) used or proposed for treating wastewater or sludge.*
*