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2. ATTENTION: After completing this survey, print it as a PDF and save it to your computer. Then, make sure to attach it to the appropriate field in the Pre Treatment Questionnaire
4. General Information:
6. Facility Contact*
8. Facility Name*
9. Facility Phone Number*
11. Facility Address*
13. Information on Process:
15. Are the following processes or activities performed at your facility?
17. Brewing:*

    1. Yes
    2. No
18. Distilling:*

    1. Yes
    2. No
19. Winemaking:*

    1. Yes
    2. No
20. Bottling:*

    1. Yes
    2. No
22. Kegging:*

    1. Yes
    2. No
23. Equipment Sanitization:*

    1. Yes
    2. No
24. Production Area Sanitization:*

    1. Yes
    2. No
25. Other*

    1. Yes
    2. No
27. If you replied "Yes" to "Other" in the question above, please specify below:
29. Is wastewater generated as a result of this process or activity discharged to the sanitary sewer system?
31. Brewing:*

    1. Yes
    2. No
32. Distilling:*

    1. Yes
    2. No
33. Winemaking:*

    1. Yes
    2. No
34. Bottling:*

    1. Yes
    2. No
36. Kegging:*

    1. Yes
    2. No
37. Equipment Sanitization:*

    1. Yes
    2. No
38. Production Area Sanitization:*

    1. Yes
    2. No
39. Other*

    1. Yes
    2. No
41. If you replied "Yes" to "Other" in the question above, please specify below:
43. What is the production rate of your operation?
45. Monthly total of Barrels, Kegs, or gallons:*
46. Yearly total of Barrels, Kegs, or total gallons:*
48. Seasonal average spring:*
49. Seasonal average summer:*
50. Seasonal average fall:*
51. Seasonal average winter:*
53. On average, how many bad/unconsumable batches are produced each year?*
55. Describe how your bad/unconsumable batches are disposed of: *
57. Describe how you dispose of spent grains, yeast, or fermented fruit: *
59. Do you have documentation of proper grain, yeast, or fermented fruit disposal? (You may be asked to present documentation) *

    1. Yes
    2. No
60. Does this facility currently treat the non-domestic waste streams before discharging to the sanitary sewer system? *

    1. Yes
    2. No
62. If you replied "Yes" to treating non-domestic waste streams before discharge, please describe the process:
64. Does this facility have plans for future expansions of the brewing, distilling, or fermenting processes? *

    1. Yes
    2. No
65. If yes, please describe:
67. Is there food service at your location that discharges to the sanitary service? *

    1. Yes
    2. No
68. If yes, please explain:
70. Is your company currently permitted with Federal, State or Municipal Authorities? *

    1. Yes
    2. No
71. If yes, specify which agency and list the permit number:
73. Certificate of Information
75. The undersigned is a principle or managerial agent for the survey respondent with authority concerning requirements for wastewater discharge from the facility.

    I hereby certify, under penalty of law, that this document and all of its attachments were prepared under my direction or supervision according to a process designed to ensure that qualified personnel properly gather and evaluate the information submitted. The information is, to the best of my knowledge and belief, true, accurate, and complete.

77. Title*
78. First Name*
79. Last Name*
81. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
83. Electronic Signature*
85. ATTENTION: After completing this survey, print it as a PDF and save it to your computer. Then, make sure to attach it to the appropriate field in the Pre Treatment Questionnaire
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86. Print Only

* indicates a required field