Water Pollution Control Division: Quarterly Report Public Works - Home | Departments

Please indicate the month that corresponds to the end of the quarter for which this report is being submitted:

March June September December

Facility Name:

Street:

City: State: Zip:

Designated Facility Contact:

Name:

Title:

Telephone Number:

Grease Hauler Name:

Telephone number:

Have any repairs been made to the grease interceptor/trap? Yes No

Your e-mail address: (optional)
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