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.

Self Monitoring Report (SMR) 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
• 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: PDF

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

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: MS Word or PDF