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Automotive & Washing Establishment Permit Application

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.

Section I

Contact Information

Name of Business (including store number, if applicable)

Contact (Name & Title)

Contact Phone Number

Contact Email

Business Fax Number

Business Physical Address

Address or Location

Business Owner (Corporation, LLC, etc)

Owner Contact (Name & Title)

Owner Phone Number

Owner Email

Owner Fax Number

Owner Mailing Address

Address or Location

Does your Automotive and/or Washing establishment have a connection with the City of Gastonia/Two Rivers Utilities Sewer System?

Yes

Section II

How many employees does your business employ?

What are your operating hours?

Describe the type of business your company conducts. (Select all applicable)

Automotive Repair

Vehicle Washing

Engine Washing

Pressure Washing

Oil Change

List all cleaning agents used at your establishment.

Please upload the Safety Data Sheet (SDS/MSDS) for each cleaning agent used.

Click Here to Upload

Section III

List the approximate volume of water (in gallons) discharged into the sanitary sewer system each operating day.

Is an Outdoor Recycle Bin or Internal Tank & Pump System used?

Yes

If yes, which one?

Outdoor Recycle Bin

Internal Tank & Pump

Where is your wastewater discharged into the sewer system (building drain, manhole, etc.)?

Is any water discharged into the Storm Water system?

Yes

Please list the approximate volume (in gallons) of water discharged into the Storm Water system each operating day.

Is your wastewater treated prior to discharge into the City of Gastonia/Two Rivers Utilities sanitary sewer system?

Yes

Please describe the system (select all applicable).

Oil and Grit Interceptor

Oil Recovery Unit

Filtration

pH Adjustment

Waste Hauler Company Name

Waste Hauler Phone Number

List material(s) hauled off.

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?

Yes

If yes, please describe.