PO Box 1748
Gastonia, NC 28053
This form is to be completed by an Authorized official of your firm, as defined in the Sewer Use Ordinance.
An Authorized official is defined as a person responisble for the principle business decisions of other policy decisions for the facility.
Failure to submit this form may result in enforcement action in accordance with the City of Gastonia/Two Rivers Utilities and Industrial Wastewater Pretreatment Ordinance.
Business Physical Address
Owner Mailing Address
Does your Automotive and/or Washing establishment have a connection with the City of Gastonia/Two Rivers Utilities Sewer System?
Describe the type of business your company conducts. (Select all applicable)
Please upload the Safety Data Sheet (SDS/MSDS) for each cleaning agent used.
Is an Outdoor Recycle Bin or Internal Tank & Pump System used?
If yes, which one?
Is any water discharged into the Storm Water system?
Is your wastewater treated prior to discharge into the City of Gastonia/Two Rivers Utilities sanitary sewer system?
Please describe the system (select all applicable).
Is bio-remediation technology (liquid or powdered bugs or enzymes) practiced and added to the drainage system, Oil and/or Grit Interceptor, or to any wastewater discharged to the City sewer system?