QES Management System

QES Management System Issue Date: 23/03/2017

Application for Trade Waste Agreement or Consent

This application is for industrial and commercial customers, except for commercial food establishments, who must complete an Application for Trade Waste Consent (Food Business) available at citywestwater.com.au/food Trade waste pricing Application, Agreement and Discharge Fees are applicable to all trade waste customers and are subject to change annually. Current fees are set out in the City West Water Pricing Handbook available at citywestwater.com.au/businessprices

1. Reason for application Dates (day/month/year)

New site Date for commencement of discharge / / Change of occupier or site operator Date of changeover (if applicable) / / Change to the nature of trade waste discharged Agreement renewal or update by City West Water

2. Address of site from which trade waste will be discharged

Shop/unit: Street number: Site address: Suburb: Postcode: Melway ref:

3. Postal address (if not the same as site address) Postcode:

4. Billing address (if not the same as site address) Postcode:

5. Who is the occupier/operator of the site from which trade waste will be discharged?

Company name or individual business owners’ names (if not a company): Trading name: Australian Business Number (ABN): Australian Company Number (ACN): Company registered office or individual’s home address (if not a company):

6. Who is the contact person responsible for the trade waste management of the site?

Title and name: (eg. Mr. John Smith) Position: Business phone: Mobile phone: Email address:

Document FOR-18 Rev 5 Page 1/4 QES Management System Issue Date: 23/03/2017

7. Who is the contact person responsible for the trade waste accounts? (if different to the person nominated in question 6)

8. Which senior executive should City West Water contact in case of an emergency?

9. What are the trading days and house of operation during which trade waste will be discharged? Days of the week (tick appropriate) Hours of the day 7 days 24 hours Monday to Friday Between and Saturday Between and Sunday Between and

10. What does your business do?

11. Please describe the types of processes that generate trade waste

12. Please attach each of the following: a) a list of all chemicals that may be present in the trade waste discharge, including those stored on site that have the potential to enter the sewerage system. Please attach Safety Data Sheets (SDS or equivalent) for propriety products and chemicals if you cannot describe their chemical composition b) a site plan layout (A3 size) which specifies the following: i. details and locations of all the fixtures (trade waste sources), tanks, pits and apparatus associated with the generation and treatment of trade waste, as well as site boundaries, north point and address ii. a legend showing all fixture numbers, description of processes and treatment apparatus c) a flow diagram (A3 size) of the proposed treatment apparatus which specifies the following: i. capacity, dimensions, and material of construction (including internal lining) of all pits and tanks ii. dosing equipment, pumps (with respective flow rates), flow measuring equipment and associated instrumentation d) an operation and maintenance schedule for any treatment apparatus and instrumentation.

13. Please describe how stormwater run-off from this site is managed and discharged (attach a separate layout plan if necessary)

14. Has a risk assessment been performed for this site which considers both of the following? a) the prevention and containment of spills and firewater. b) contingency, emergency trade waste storage or alternative means of disposal when: i. your trade waste is non-compliant with the terms or conditions of you Trade Waste Agreement or Consent ii. City West Water may require discharge of trade waste to cease temporarily. If yes, please attach a copy of this plan No

15. Please complete the table on the last page and list the processes or activities that will generate trade waste, along with the projected volumes from each of these trade waste streams.

Terms and Conditions For information about trade waste services and the respective rights and responsibilities of City West Water and its trade waste customers, By accepting the following terms and conditions you are confirming that you please refer to our Trade Waste Customer Service Charter available at have the authority to both make the statements set out in the form and to give citywestwater.com.au/documents/trade_waste_customer_charter.pdf the following undertakings set out below to City West Water on behalf of the occupier. Important privacy notice If City West Water accepts the occupier’s offer contained in this application, the occupier will: City West Water ABN 70 066 902 467 is a company owned by the Victorian State  comply with all the requirements of any trade waste agreement or Government, which provides retail water, sewerage and trade waste services to consent as issued by City West Water and any notice provided by City Melbourne’s central business district, inner and western suburbs. West Water By completing this form you are providing personal information to City West  ensure that all plumbing or drainage work on the site and all connected Water for the primary purpose of providing you with a trade waste agreement or fittings or appliances comply with all requirements of Australian consent, which is required by law to allow you to discharge trade waste to City Standards, the relevant plumbing codes and any trade West Water’s sewerage system. The personal information contained in this form waste requirements imposed by City West Water. All plumbing may be shared between, and used by, City West Water and its contracted service works must be carried out by a licensed plumber providers for the above primary purposes, and purposes related to providing and  authorise contractors, employees and agents to provide City West Water marketing City West Water’s water supply, sewerage and trade waste services. with maintenance receipts associated with any trade waste treatment Additionally, City West Water may share your personal information with service apparatus on the site providers and other external organisations in limited circumstances.  pay trade water application and agreement fees from the start of the If you do not provide the information requested by this form, we may consent, as billed by City West Water. not be able to issue you with a Trade Waste Agreement or Consent. Prior to connection of a waste water treatment apparatus to a City West Water You may request access to your personal information which City West Water sewer, a Commercial/Industrial/Multi unit/ Dual occupancy Application must be holds about you by writing to the Privacy Officer at Locked Bag 350, Sunshine, lodged, and the appropriate fee paid. 3020. It is against the law for you to discharge trade waste until you have an executed Trade Waste Agreement or Consent.

SIGNED by or on behalf of the occupier Signature: Name (block letters): Date: / / Position:

City West Water Locked Bag 350, Sunshine, Vic, 3020 | T (03) 9313 8366 | E [email protected]

OFFICE USE ONLY:

Application lodgment date: Application received by:

Customer contact date: Contact method:

15. List the processes or activities on the site that will generate trade waste in the table below and include projected volumes from each of the waste streams. The daily volume and discharge rates indicated below will be considered in determining trade waste application and agreement fees as well as flow rate compliance.

Fixture ID Site process or activity What is in the trade waste? (Attach SDS where available) Max. vol. Avg. vol. Max. vol. Max. vol. Max. vol. (match to (kL/day) (kL/day) (L/hr) (L/min) (L/sec) site plan)

Totals: Where more space is required, please photocopy the above table or request additional copies from City West Water and submit with the completed application.

Document FOR-18 Rev 5 Page 4/4