The form will take 30-45 minutes to complete.
Initial Compliance Report for Dental Dischargers
All Dental Practices must submit an Initial Compliance Certification Report — even if the practice seems like it could be exempt from the required best management practices of the Dental Amalgam Rule.
This is a one-time form that will only need to be resubmitted if an office has a change in name, address, or ownership, or if its practices regarding dental amalgam change.
Initial Compliance Report Due Dates: If your practice opened after July 15, 2017, the report is due 30 days after the practice opened. If you purchased an existing practice, the new owner must submit the report within 30 days of taking ownership.
The EPA requires an original signature on this report.
Please mail the original form to:
City of Portland
Water Pollution Control Lab
Attn: Dental Amalgam Program
6543 N Burlington Ave.
Portland, OR 97203
Annual Certification
Only dental practices that are required to implement the BMPs must submit the annual certification report. Exempt practices do not need to meet this ongoing reporting requirement.
Annual Report Due Dates: This report must be received by the City no later than January 31 of each year, certifying that the dental practice complied with all best management practices during the previous year. The certification does not require an original signature.
Submit the completed form.
By email: BESADCM@portlandoregon.gov
By mail:
City of Portland
Water Pollution Control Lab
Attn: Dental Amalgam Program
6543 N Burlington Ave.
Portland, OR 97203
Program Fee
The annual program fee is currently $190. The annual fee assists in recovering costs associated with permitting, inspecting, and monitoring facilities that meet the City’s ADCM requirements. It is reassessed annually to account for changing program costs. The fee is billed at the start of the fiscal year in July.
Resources
Find more information in the Guide to the Dental Amalgam Rule or contact Alternative Discharge Control Mechanism Permitting at BESADCM@portlandoregon.gov.