2. Food Service Facility - Grease Control Permit Application
   City of Mt. Juliet
4. Name of Facility
6. Address
8. Phone Number
9. Fax Number
11. Authorized Representative Information
13. Name of Authorized Representative
14. Title
16. Email Address
17. Phone Number
19. Owner Information
    (If different from Authorized Representative)
21. Name of Owner
23. Email Address
24. Phone Number
26. Facility Information
28. Available Seating
29. Number of Employees
30. Number of Meals Served Per Day
32. Day(s) the Facility is in Operation

    1. Monday
    2. Tuesday

    1. Wednesday
    2. Thursday

    1. Friday
    2. Saturday

    1. Sunday

    Check all that apply.
34. Provide the Hours of Operation for the Days Selected Above.
36. Are kitchen sinks connect to a garbage disposal?

    1. Yes

    1. No
38. Is the dishwasher connected to a grease trap?

    1. Yes

    1. No
40. Are pots, pans, dishes, etc. "dry wiped" before washing?

    1. Yes

    1. No
42. Identify the Types of Equipment Used

    1. Grill
    2. Deep Fryer

    1. Stove
    2. Other
43. If Other, Specify
45. What is done with the grill cleanings and deep fat fryer oil?
47. Grease Control Equipment
49. 1. Is a grease trap* installed at the facility?

    1. Yes

    1. No

    *A grease trap is an indoor unit, normally under the sink with 50 gallons or less capacity
    
    If the answer to question 1 is "No", then go to question 7.
51. 2. Number of Grease Traps Installed
52. 3. Grease Trap Capacity / Volume
54. 4. Frequency the Grease Trap is Cleaned
56. 5. Describe the method of disposal for grease trap contents:
58. 6. Estimated Monthly Volume of Grese Trap Waste Disposed
60. 7. Is a grease interceptor* installed at the facility?

    1. Yes

    1. No

    *A grease interceptor is an outdoor, underground grease retention unity with baffles; normally 100-250 gallons in capacity.
62. 8. Grease Interceptor Capacity/Volume
64. 9. Are enzymes, biological or microbiological agents, or chemicals added to the Grease Interceptro for control of grease?

    1. Yes

    1. No
66. 10. Frequency that the Grease Interceptor is serviced (cleaned/pumped out):
68. 11. name of Grease Hauler (cleaner/pumper) used:
70. 12. Do you have copies of manifests from the Grease Hauler?

    1. Yes

    1. No
72. 13. When was the last time the facility's grease interceptor was cleaned?
74. Certification Statement
    I certify, under penalty of law, that the above mentioned information is true and accurate to the best of my knowledge.
76. Signature
77. Date
    Date
Leave This Blank:


79. 1. Receive an email copy of this form.
80. Email address

    This field is not part of the form submission.

81. Submit

* indicates a required field