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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 will help you meet the reporting requirements found in Lyons Municipal Code 13-4-160 (b). 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. If you do not use a contracted grease waste hauler, the Town may require additional inspections.
  8. Cleaning Performed By:
  9. Please submit the CDPHE WG-2 Form from your contractor.
  10. Monthly Cleaning Activity Reporting
    Specify Month, Date of Cleaning & Amount of material pumped/cleaned out of trap:
  11. By checking this box...
  12. Leave This Blank:

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