Diamond Bar, CA · Los Angeles County
One-Time Compliance Report for Dental Discharges
Dental offices use this report to provide the County Sanitation Districts of Los Angeles County with information about their wastewater discharges and amalgam practices.
What this form is
This report collects facility and contact details, wastewater discharge timing, chair counts, amalgam separator information, and required certifications. Dental offices that discharge wastewater to the sewer must submit it to the County Sanitation Districts of Los Angeles County, the Control Authority identified in the document. The form provides different completion instructions depending on whether the office places or removes amalgam.
Who needs it
Dental offices that discharge wastewater to the sewer use this report, including offices that do not place amalgam but may remove it in limited circumstances.
How to submit it
Submit the report to the County Sanitation Districts of Los Angeles County, Industrial Waste Section, 1955 Workman Mill Rd., Whittier, CA 90607.
About notarization
This document is signed and dated without a notary; the authorized official certifies the information under penalty of law.
How to submit this form
- 1
Download The Report
Download the One-Time Compliance Report for Dental Dischargers.
- 2
Complete The Applicable Sections
Provide facility details and complete the sections that apply to the office’s amalgam practices and devices.
- 3
Gather Any Attachments
Include any attachments prepared with the report, as referenced in the certification.
- 4
Sign And Submit
Have an authorized company official sign and date the certification, then mail the report to the Industrial Waste Section address shown.
Frequently asked questions
- What information does the dental discharge report request?
- It asks for facility and contact details, wastewater discharge timing, chair counts, amalgam separator or equivalent device information, and an authorized official’s certification.
- Who submits the One-Time Compliance Report?
- Dental offices that discharge wastewater to the sewer submit the report to the County Sanitation Districts of Los Angeles County, identified as the Control Authority.
- Do I need a notary for the dental discharge report?
- No. The authorized company official signs and dates the certification without a notary; the certification is made under penalty of law.
- How do I submit the dental discharge report?
- Send it to the County Sanitation Districts of Los Angeles County, Industrial Waste Section, 1955 Workman Mill Rd., Whittier, CA 90607.