HomeMy WebLinkAboutAPPENDIX J - 20-00497 - 15 N 12th W - City Sewer Hook-upRi.+:uc kr.
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City of Rexburg
Pretreatment Business Information Form
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A. Date submitted:
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Facility Name Facility Owner Name Facility Operator (if different)
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B. Site address of facility discharging the wastewater:
C. Mailing address if different than Facility:
Contact Name Job Title
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D. Description of business: L' '<-'-hr
Phone Number(s)
E -Mail Address
E. Nature and type of process/service operations: �.��'� ,�jS e-
May-
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F. Estimated number of employees:
G. Estimated business hours: ( ayv-, — /
H. Is this anew or existing building:
I. Is this a current business that is changing its process/service: bj.. Y�sS
J. Besides normal, household chemicals, are there going to be chemicals on sight: 1?L1)
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K. Will this business be in a stand-alone building or part of a complex:irakl�i iwy
L. Name of complex (if answered complex on K.)
Note: After review of this form, AppendixJ may be required for more information prior to any operation.