Who uses the New Source Dental Discharge Form?

Dental facilities subject to the Dental Rule use the included One-Time Compliance Report when beginning amalgam wastewater discharge or transferring ownership.

When does the report need to be returned?

The packet says new dental offices must return it within 90 days after introducing wastewater to the sanitary sewer; ownership transfers must return it within 90 days after the transfer.

Do I need a notary for the New Source Dental Discharge Form?

No. The document is signed and dated without a notary. Its certification is under penalty of law, but the text does not require a sworn or notarized attachment.

North Richland Hills, TX · Tarrant County

No notary required

New Source Dental Discharge Form

This packet guides new dental dischargers and businesses transferring ownership through the Dental Rule and includes a One-Time Compliance Report to complete and submit.

What this form is

The packet summarizes the Dental Rule, offers compliance guidance, and includes a One-Time Compliance Report for dental facilities that discharge amalgam wastewater. New dental offices must return the report within 90 days after wastewater is introduced to the sanitary sewer; facilities transferring ownership must return it within 90 days after the transfer. The report requests facility, ownership, equipment, maintenance, and certification information.

Who needs it

Dental facilities subject to the Dental Rule use the report when beginning amalgam wastewater discharge or transferring ownership.

How to submit it

The packet says to email the completed report to both the Trinity River Authority and the City/Town; it does not provide completed recipient email addresses.

About notarization

This document is signed and dated without a notary; its certification is under penalty of law, and the text does not require a sworn or notarized attachment.

How to submit this form

1
Download The Packet
Download the New Source Dental Dischargers packet and its included One-Time Compliance Report.
2
Complete The Report
Provide the requested facility, ownership, discharge, separator, maintenance, and certification information.
3
Gather Required Documentation
If a designated signatory is used, include the written authorization required by the report.
4
Email The Report
Email the completed report to both the Trinity River Authority and the City/Town, as instructed in the packet.

Frequently asked questions

Who uses the New Source Dental Discharge Form?: Dental facilities subject to the Dental Rule use the included One-Time Compliance Report when beginning amalgam wastewater discharge or transferring ownership.
When does the report need to be returned?: The packet says new dental offices must return it within 90 days after introducing wastewater to the sanitary sewer; ownership transfers must return it within 90 days after the transfer.
Do I need a notary for the New Source Dental Discharge Form?: No. The document is signed and dated without a notary. Its certification is under penalty of law, but the text does not require a sworn or notarized attachment.
How do I submit the report?: The packet instructs dental facilities to email the completed report to both the Trinity River Authority and the City/Town. The recipient email addresses are not completed in the packet.

Need something notarized?

This New Source Dental Discharge Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.