Trade Effluent Discharge Consent Application Form

Applicant Name

First NameMiddle NameLast Name

Business / Organization Name

Job Title / Role

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Registered Business Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Site / Trading Address (if different)

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Responsible Person for Application

First NameMiddle NameLast Name

Discharge location on site

Source or process generating the effluent

Type of trade effluent

Estimated average daily discharge volume

Maximum peak discharge volume

Discharge frequency or schedule

Discharge pattern

Likely pH Range

Expected Temperature (°C)

Solids or Visible Contamination

Contaminants Expected in Effluent

Chemicals or Substances Present

Pre-treatment or Control Measures Before Discharge

Receiving infrastructure type

Connection status

Monitoring and sampling arrangements

Spill prevention and emergency response procedures

Supporting documents