Trade Waste Application Form

Applicant Details

Full name of Applicant: (Block letters)
Postal Address: (For correspondence)
Ph:
Fax:
Email:

Discharging Property Details

Business/Company Name:
Trading As: / ACN/ABN:
Full name of person responsible for trade waste management of the site: (Block letters)
Position in company:
Business address: (Where discharge will occur)
Ph:
Fax:
Email: / A/H number:

Application Type:

New application / Variation to existing approval/permit / Renewal of existing approval/permit

Office Use Only

LD# / ASSET# / PERMIT#

Describe the type of Business carried out on site.

………………………………………………………………………………………………………………………………………………………………………

What type of processes on the site generate trade waste?

………………………………………………………………………………………………………………………………………………………………………

Indicate the days and hours during which the discharge will take place

Monday to FridayBetween…………….and……………….

SaturdayBetween…………….and……………….

SundayBetween…………….and……………….

Are any of the following contaminates present in the trade waste to be discharged to sewer? (please tick)

Oil/ Grease Disinfectants Paint

Acids/Alkalis Heavy metals Food waste

Solvents PesticidesSulphur based products

Hydrocarbons Petrochemicals Ammonia

Cyanide Photographic Waste Other (specify below)

……………………………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………

State maximum volumes and flow rates of projected trade waste discharge (if known)

Litres per hour / Litres per minute / Kilolitres per day

Please describe how stormwater run-off from this site is managed and discharged.

……………………………………………………………………………………………………………………………………………………………………
Please attach Material Safety Data Sheets (MSDS) for proprietary products and chemicals used on site, if requested by the Power and Water Authorised Officer.

……………………………………………………………………………………………………………………………………………………………………

Please include a layout plan with the following requirements, if requested.

(a)details and location of all fixtures, tanks, pits and trade waste apparatus that is

associated with the generation and treatment of trade waste discharge.

(b)a plan of the site showing the fixtures, description of processes and treatment apparatus.

Signature of Applicant

This application must be signed below by a person who has the authority to make the statements set out above.

If Power and Water accepts the Occupiers offer contained in this application, the Occupier will-

(i) comply with all the requirements of any trade waste agreement or permit

(ii) ensure that all plumbing or drainage work on the site and all connected fittings or appliances comply with the requirements of Australian Standards, the relevant Plumbing Code and Trade Waste requirements of Power and Water.

(iii) pay any applicable trade waste fees and charges,assessed by Power and Water Corporation, from the commencement or re-assessment date of the agreement or permit.

Signature of applicant:
Name
(printed) / Date:
Position:

Return all correspondence to: Manager Trade Waste

Power and Water Corporation

PO Box 37471WinnellieNT 0821

Fax No:08 8924 5121

Reference:
Trade Waste – Trade Waste Application form
Version No.:3 / Date reviewed 05/12/2011 / EDMS document No.: QDOC2010/1

Document Valid for day of Printing only. Printed on Friday, 16 February 2007

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