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WPCA FOG REGISTRATION FORM 1

  1. FORM 1: PERMIT COMPLIANT PRETREATMENT SYSTEM

  2. IF YOU CURRENTLY HAVE A CLASS 3 OR 4 FOOD SERVICE LICENSE FROM NCDHD- PLEASE ANSWER QUESTIONS 1 THROUGH 5.

  3. By completing this section you are certifying that your FOG pretreatment meets all requirements of "FOG fact Sheet 2" or FOG Fact Sheet 3".

  4. YOU MUST ATTACH TWO YEARS OF MAINTENANCE RECORDS TO THIS SUBMISSION.

  5. If you have an external in-ground tank, the next pump-out must be witnessed by the grease inspector. Please call 860-253-5248 or 860-253-6450 to schedule this inspection.

  6. ALL FACILITIES WILL BE INSPECTED AND THE INSPECTION FEE IS $50.00. RE-INSPECTIONS WITHIN 30 DAYS ARE FREE.

  7. QUESTION 1

  8. Please complete the following for EACH installed grease trap. If you do not have a grease trap, indicate "No grease trap" in MANUFACTURER field.

  9. GREASE TRAP #1

  10. Passive/Automatic

  11. Indoor/Outdoor

  12. GREASE TRAP #2

  13. Passive/Automatic

  14. Indoor/Outdoor

  15. QUESTION 2

  16. If you have an indoor grease trap (AGRU), how do you dispose of the waste after cleaning the trap?

    PLEASE SELECT ONLY ONE:

  17. QUESTION 3

  18. Licensed Rendered Company Information:

    If a Licensed Rendered Company Maintains your AGRU, please provide the following information:

  19. QUESTION 4

  20. If waste fats, oils and grease are stored on the premises from fryolators or other sources, where is this material stored?

  21. QUESTION 5

  22. If an outdoor, in-ground grease trap is utilized, list the name and telephone number of the company who pumps out the grease interceptor:

  23. IF MORE THAN TWO GREASE TRAPS ARE INSTALLED, PLEASE SUBMIT ANOTHER FORM AND PROVIDE INFORMATION ON THE OTHER GREASE TRAPS AT YOUR FACILITY.

  24. (August 2016)

  25. Leave This Blank:

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