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HomeMy WebLinkAboutAPPENDIX J - 20-00497 - 15 N 12th W - City Sewer Hook-upRi.+:uc kr. C[ l Y U P J REX.BuRG ..„rr,..... City of Rexburg Pretreatment Business Information Form � _7 A. Date submitted: ro Facility Name Facility Owner Name Facility Operator (if different) 1� B. Site address of facility discharging the wastewater: C. Mailing address if different than Facility: Contact Name Job Title H D. Description of business: L' '<-'-hr Phone Number(s) E -Mail Address E. Nature and type of process/service operations: �.��'� ,�jS e- May- eS h� I S�1 YV10 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) A 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.