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Page 1 of 5 DEP WQ-D-001/Wastewater quality control Application/Rev. 8-1-13 NEW york city DEPARTMENT OF ENVIRONMENTAL PROTECTION FOR OFFICIAL USE ONLY C- BUREAU OF WASTEWATER TREATMENT Wastewater quality control Application PLEASE PRINT OR TYPE. APPLICANT MUST COMPLETE BOTH PAGES OF THIS FORM. INCORRECT OR INCOMPLETE applications WILL NOT BE ACCEPTED AND WILL BE RETURNED. WRITE N/A IF NOT APPLICABLE. PLEASE RETURN COMPLETED FORM TO: New york city Department of Environmental Protection Division of Pollution control and Monitoring Industrial Inspections and Permitting Section 96-05 Horace Harding Expressway, 1st Floor Corona, NY 11368 1. LOCATION TAX BLOCK # LOT#: PROJECT NAME: BOROUGH: HOUSE#: STREET NAME: ZIP: IS THIS A DEP PROJECT?

Page 1 of 5 DEP WQ-D-001/Wastewater Quality Control Application/Rev. 8-1-13 . NEW YORK CITY DEPARTMENT OF ENVIRONMENTAL PROTECTION . FOR OFFICIAL USE …

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