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Grease Trap/Pretreatment Reporting Form

  1. This form is to be completed by the owner or person responsible for the grease or sand trap at this facility. This form must be submitted to the Town Of Lyons on a quarterly basis. Failure to meet this requirement is a violation of Lyons Municipal Code 13-4-140(b)(11). If you have any questions about the required information, please contact

  2. Quarterly Reporting Due Dates

  3. Quarter 1 - April 10

  4. Quarter 2 -July 10

  5. Quarter 3 - October 10

  6. Quarter 4 - January 10

  7. Option 2.
    If your business does not contract a grease waste hauler, please fill-in the following fields.

  8. Cleaning Performed By:

  9. Monthly Cleaning Activity Reporting

    Specify Month, Date of Cleaning & Amount of material pumped/cleaned out of trap:

  10. By checking this box...

  11. Leave This Blank:

  12. This field is not part of the form submission.