Pressure Washing and Surface Cleaning
Clean Water Business Partner Survey

In the course of providing services, some businesses generate wastewater.  If properly dealt with, this is not a problem.  When wastewater is disposed of improperly into the storm drain system, pollutants go directly into our waterways with no treatment.

Clean Water Business Partners make a commitment to properly dispose of their wastewater.  By doing this, they help to ensure that future generations can use and enjoy our most valuable natural resource...water!  Join the City of Chico and Butte County in a Clean Water Business Partnership, and receive promotional benefits!
Number of Employees:____________________  Years of Business:______________
1. What types of surfaces do you clean?  (Check all that apply)      	
☐ Building exterior 	☐ Sidewalks/plaza	☐ Parking area/drive-throughs   
☐ Dumpster area/grease storage 	☐ Paint/graffiti removal
☐ Automobile wash/detail   			
☐ Other: __________________________________________

2.  What types of cleaning equipment do you use?  (Check all that apply)      	
☐ Truck mounted 	☐ Portable Unit	☐ Pressure-washer   		
☐ Other: __________________________________________

3.  On a typical day, how many jobs does an operator complete?
☐ 1		☐ 2		☐ 3		☐ 4 		☐ 5		☐ _______

4.  What types of cleaning methods do you use?
☐ Water only 		☐ Water and soap  	 	☐ Acid wash    
☐ Wet sand blast    	  	
☐ Other chemicals (list)_________________________________________________________	
☐ Other (describe) ____________________________________________________________

5.  What precautions do you take to prevent pollutants from entering the storm drain system?
☐ Dry cleanup (sweeping, absorbents)	☐ Block storm drain  	 	
☐ Runoff    ___ contained  ___ screened  ___ collected  ___ pH adjusted			
☐ Other (describe) __________________________________________________________

6.  How do you currently dispose of wastewater generated during cleaning on site?  
Please check all that apply.  
☐ Landscaping/unpaved area		☐ Gutter, street, storm drain
☐ Sanitary sewer		☐ Hazardous waste disposal	
☐ Transport wastewater for discharge off-site.  Where? _________________________
☐ Other (describe) __________________________________________________________

7.  What type of training do you and your employees receive regarding wastewater containment and disposal?  Please check all that apply.
☐ On-site teaching and demonstrations
☐ Workshop and/or seminars provided by parent corporations/ literature and brochures
☐ None
☐ Other _____________________________________________________________________

8.  Do you have customers that refuse to allow you to discharge wastewater into a sanitary sewer system?
☐ Yes		☐ No		If “yes”, approximately how many each month?__________

9.  How would you classify the majority of chemicals you use for surface cleaning?
☐ Rated 1 or 2, biodegradable and/ or environmentally friendly
☐ Rated 3, medium harsh
☐ Rated 4 or 5, harsh

10.  Are you affiliated with any professional cleaning organizations?
☐ List ______________________________________________________________

11.  Do you consider when a building/residence was built when determining cleaning methods? (After 1978 is lead-free)
☐ Yes			☐ No

12.  Would you be willing to be recognized as a Clean Water Business Partner?
☐ Yes			☐ No

By signing this form you agree that the information you provide on this form is true and correct.

__________________________________________	________________________
Signature					Date

The Clean Water Business Partnership Program is funded by the City of Chico.