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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 firstname.lastname@example.org
Quarter 1 - April 10
Quarter 2 -July 10
Quarter 3 - October 10
Quarter 4 - January 10
Specify Month, Date of Cleaning & Amount of material pumped/cleaned out of trap:
This field is not part of the form submission.
* indicates a required field