tylera@tworiversutilities.com
PO Box 1748 Gastonia, NC 28053
(704)214-9117
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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 food establishment have a connection with the City of Gastonia/Two Rivers Utilities Sewer System?
What meals do you serve? (Select all applicable)
Is your establishment used as the base location for any mobile food service units?
How do you classify your establishment? (Please check all that apply)
What menu item(s) does your establishment serve? (Please check all that apply)
Is disposable serving ware used?
Will you be using fryer equipment?
Is an Outdoor Recycle Bin or Internal Tank & Pump System used?
How often is it cleaned out?
What date was it last cleaned?
Where is the Grease Trap and/or Interceptor located? (If you were facing the front of the establishment)
Please select the number of each of the following kitchen wastewater sources (please do not include bathroom fixtures):
Please select the number of each of the following pieces of equipment:
Is bio-remediation technology (liquid or powdered bugs or enzymes) practiced and added to the drainage system, Grease Trap/Interceptor, or to any wastewater discharged to the City sewer system?
