Wastewater Discharger Forms
Commercial businesses and industrial users who discharge wastewater to the sanitary sewer system in the jurisdiction of the San José-Santa Clara Regional Wastewater Facility may be required to complete these forms. If you have questions or need assistance, please contact a Source Control Inspector at (408) 945-3000.

Wastewater Discharge Application Forms

• Wastewater Discharge Permit Application: MS Word or PDF
• Short Term (1 year) Wastewater Discharge Permit Application: PDF

Wastewater Discharge Application Forms should be submitted to the Senior Environmental Inspector at:

City of San José, Environmental Services
Watershed Protection Division
200 E. Santa Clara Street, 7th Floor
San José, CA 95113

(408) 793-5300 or (408) 945-3000

Zero Discharge Certification Forms

• Zero Discharge Certification Form: MS Word or PDF    

TTO Certification Forms For Your SMR

• If you DON'T have TTO's:
  • We don't have TTO's: MS Word or PDF
• If you DO have TTO's:
  • We do have TTO's: MS Word or PDF
  • Organic Solvent Worksheet: MS Word or PDF

Self Monitoring Report Forms

• Self Monitoring Report: MS Word or PDF
• Self Monitoring Report Fact Sheet (PDF) 
• Baseline Monitoring Report, due 90 days after first discharge at a new facility: MS Word or PDF

Signatory Requirement Authorization
Certification Form for Assigning a Duly Authorized Representative: PDF