Local certification form
The district requires all local dental clinics to certify annually that they are managing amalgam waste according to local requirements. The paper certification form is linked below.
MMSD amalgam certification form
EPA compliance forms
EPA also requires amalgam reporting information from all clinics that discharge amalgam waste into sewer systems. Under the EPA dental effluent rule, clinics are required to send a one-time compliance report to their local control authority. If your clinic is new in the MMSD service area, or if you have assumed ownership of an existing clinic in the area, submit the corresponding form below to MMSD within 90 days of beginning operation or transferring ownership:
New clinic: One-Time Compliance Report
Existing clinic Transfer of Owner One-Time Compliance Report
The EPA rule requires that dental clinics maintain records of amalgam separator inspections, replacements and repairs. You can use the example logs linked below or develop your own system to meet these requirements of the rule.
Separator inspection and replacement logs