Wastewater treatment in highway service areas in plateau and cold climate is challenging due to the specific and extreme environment situation. The goal of this study is to investigate and evaluate wastewater characteristics and current treatment technologies in these areas in China. The combination of temperature, equipment and technology under the circumstances were investigated, and three cases referring to AAO, MBR and MBBR systems were discussed respectively. It was found that low temperature, low oxygen and low pressure would lead to problems of low water temperature, low dissolved oxygen and high variability of inflow for wastewater treatment. In this case, elaborate design before construction is necessary. Online monitoring and control systems are recommended for wastewater treatment facilities in these cold areas to manage daily work and uncertainties.