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.

40 CFR 437 Periodic Certification (Annual) Statement Form

• 40 CFR 437 Periodic Certification (Annual) Statement

Certification of Non-Significant Categorical Industrial User Status Form

• NSCIU Certification

Power Plant Certification Form

• Power Plant Certification

Self Monitoring Report (SMR) Forms

• Self Monitoring Report Form
• Self Monitoring Report Fact Sheet 
• Baseline Monitoring Report Form - Due 90 days after first discharge at a new facility
• Total Toxic Organic (TTO) certification forms for your SMR
• Total Toxic Organic Certification Statement Form - If your Facility is under an approved TOMP, submit this form with every SMR
• Toxic Organic Compound Worksheet Form - If Toxic Organics are stored, used, or generated at your Facility, complete this form for each chemical and submit with every SMR

Signatory Requirement Authorization Form

• Certification Form for Assigning a Duly Authorized Representative

Slug Plan Requirements and Form

• Industrial User Slug Discharge Prevention Plan Requirements Outline
• Slug Discharge Prevention Plan Certification Form

Toxic Organic Management Plan (TOMP) Forms

• TOMP Guidelines
• TOMP Certification Form - Include this certification with your updated TOMP
• List of Toxic Organic Compounds Certification Form - When developing a TOMP, use this list to identify which TTOs you might have onsite

Wastewater Discharge Application Forms

• Wastewater Discharge Permit Application
• Short Term (1 year) Wastewater Discharge Permit Application

Wastewater Discharge Application Forms should be submitted to Environmental Engineering at:

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

Zero Discharge Certification Form

• Zero Discharge Certification Form