Do I need a notary for the Wastewater Industrial User Survey?

No. The signing official signs and dates the survey; no notarized or sworn attachment is identified.

How do I submit the Wastewater Industrial User Survey?

Mail it to the City of Moses Lake, P.O. Box 1579, Moses Lake, WA 98837, Attn: Tony Pfluger, or drop it off at the engineering counter at Civic Center Annex, 321 S. Balsam.

Who must sign the survey?

The survey specifies that corporations must have it signed by a principal executive officer of at least vice president rank, partnerships by a general partner, and sole proprietorships by the proprietor.

What information does the survey request?

It asks about company and facility details, business activities, water sources, wastewater types and disposal methods, discharge amounts, and any wastewater treatment equipment or processes.

Moses Lake, WA · Grant County

No notary required

Wastewater Industrial User Survey

Moses Lake businesses complete this survey to describe facility operations, water use, and wastewater discharges to the public sewer system.

What this form is

The City of Moses Lake uses this survey to gather information about a business’s operations, water sources, wastewater, and waste disposal. Businesses with industrial or other activities that produce wastewater can use it to report discharge details, treatment processes, and related facility information. The survey must be properly signed by an authorized official to be accepted as complete.

Who needs it

Businesses whose activities produce wastewater should complete the survey and have it signed by the appropriate company official.

How to submit it

Mail the completed survey to the City of Moses Lake, P.O. Box 1579, Moses Lake, WA 98837, Attn: Tony Pfluger, Wastewater Division Supervisor, or drop it off at the engineering counter at Civic Center Annex, 321 S. Balsam.

About notarization

This survey does not require a notary; the signing official signs and dates it, and the document identifies no notarized or sworn attachment.

How to submit this form

1
Download The Survey
Download the Wastewater Industrial User Survey PDF.
2
Complete The Survey
Provide company and facility information, describe business activities, and answer questions about water use and wastewater.
3
Gather Additional Information
Attach a separate sheet if needed to provide additional information about recycled materials or cleanup and maintenance chemicals.
4
Sign And Submit
Have the appropriate company official sign and date the survey, then mail it or drop it off at the location listed on the form.

Frequently asked questions

Do I need a notary for the Wastewater Industrial User Survey?: No. The signing official signs and dates the survey; no notarized or sworn attachment is identified.
How do I submit the Wastewater Industrial User Survey?: Mail it to the City of Moses Lake, P.O. Box 1579, Moses Lake, WA 98837, Attn: Tony Pfluger, or drop it off at the engineering counter at Civic Center Annex, 321 S. Balsam.
Who must sign the survey?: The survey specifies that corporations must have it signed by a principal executive officer of at least vice president rank, partnerships by a general partner, and sole proprietorships by the proprietor.
What information does the survey request?: It asks about company and facility details, business activities, water sources, wastewater types and disposal methods, discharge amounts, and any wastewater treatment equipment or processes.

Need something notarized?

This Wastewater Industrial User Survey doesn’t need a notary — but if you have another Moses Lake form that does, a commissioned online notary can help.