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PUBLIC WORKS – UTILITIES DIVISION INDUSTRIAL WASTE PERMIT APPLICATION FOR AUTO REPAIR ESTABLISHMENTS Page 1 of 2 Establishment Information: Name: Site Address: Zip: Phone: ( ) - Email: Contact: Billing Information: Name: Mailing Address: City: ST: Zip: Phone: ( ) - Email: Was space previously occupied? If so, identify previous tenant & type of business: Days/Hours of operation: Sun. Mon. Tues. Wed. Thurs. Fri. Sat. Do you have an oil/water separator, clarifier, or sand trap? Yes No Oil/water separator, clarifier, or sand trap size and location: Will your business process any of the following? (Check Yes or No) Waste Oil Yes No Battery Storage Yes No Oil Filters Yes No Anti Freeze Yes No Other (please explain): Refrigerants (A/C) Yes No Degreaser Yes No Solvents Yes No Parts Washer Yes No OFFICE USE ONLY IW Permit Stand 5 Year Change of Ownership ---PAGE BREAK--- Page 2 of 2 How many of the following will your location contain? Restroom Floor Drains Mop sink(s) On Site Storm Drains How would you classify your establishment? Oil Change/ Lube Yes No Self-Service Car Wash Yes No General Mechanic Yes No Auto Body & Paint Yes No Transmission Repair Yes No Smog/Muffler Yes No Auto Dealer Yes No Radiator Shop Yes No Full-Service Car Wash Yes No Auto Electric Yes No Other (Please Explain): Please read and initial below: I certify that the information submitted about my establishment is accurate. I understand that the oil/water separator, clarifier or sand trap must be maintained in efficient operating condition by periodic removal of oil and sludge. I further acknowledge that the use of chemicals to clean out the oil/water separator, clarifier or sand trap is prohibited. I agree to establish routine cleaning of the oil/water, clarifier or sand trap as follows: Oil/water separators, clarifier, or sand traps must be cleaned semi-annually or as often as needed so that the oil and sludge do not exceed 25% of the device’s working capacity. A suitable maintenance schedule will be determined based on business volume and the direction of the industrial waste inspection staff. I acknowledge that I will comply with any additional City of Palmdale requirements and will inform the city of any change in management, ownership and/or use, including expansion. Print Name Signature Title Property Owner Information: Name: Assessor’s Parcel Identification: Address: