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Town of South Windsor
r^OSaR•Co HEALTH DEPARTMENT/WATER POLLUTION CONTROL
Inspection Checklist
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Date: S- 1 1
Inspector: 5-
Establishment:
Address: $'
Contact Name: G Signa
Phone:
INTERCEPTOR NUMBER
General Information #1 #2 #3
1. Was grease interceptor inspected M/Y ❑ N ❑ Y ❑ N ❑Y ❑ N
2. Grease interceptor accessible for maintenance v/y ❑ N ❑ Y ❑ N ❑Y ❑ N
❑ Y ❑ N ❑ Y ❑ N ❑Y ❑ N
❑ Y ❑ N ❑ Y ❑ N ❑Y ❑ N
Major Violations Outdoor Grease Interceptor
1. Manhole cover brought to grade,and labeled. 1 ❑ Y ❑ N ❑ Y ❑ N ❑Y ❑ N
2. Provided written contractor invoice for last cleaning 9f Y ❑ N ❑ Y ❑ N ❑Y ❑ N
3. Date of last cleaning
� 11� ZY ❑ N ❑ Y ❑ N ❑Y ❑ N
❑ Y ❑ N El ❑ N ❑Y ❑ N
Major Violations Indoor Grease Interceptor
1. Unit maintained daily M/Y ❑ N ❑ Y ❑ N ❑Y ❑ N
2. Unit energized,an utomatic ti het to ❑ Y ❑ N ❑ Y ❑ N ❑Y ❑ N
operate during business hours.
3. Screening basket in place V-f ❑ N ❑ Y ❑ N ❑Y ❑ N
4. Skimmer in working order aY-' ❑ N ❑ Y ❑ N ❑ Y ❑N
5. Heater in working order m4 ❑ N ❑ Y ❑ N ❑Y ❑ N
6. Grease collection container in place IYY/ ❑ N ❑ Y ❑ N ❑Y ❑ N
Minor Violations
4. Grease interceptor maintenance log available ❑ Y ❑ N ❑ Y ❑ N ❑Y ❑ N
5. Signs posted at all sinks ❑ Y ❑'N ❑ Y ❑ N ❑Y ❑ N
6. Pots,pans,dishes,and utensils scraped in�Y - ❑ N ❑ Y ❑ N ❑ Y ❑ N
7. Adequate renderable FOG container/sttorage Y'Y ❑N El ❑ N ❑ Y ❑ N
8. Exhaust hood properly cleaned Al�I t ❑ Y ❑ N ❑ Y ❑ N ❑ Y ❑ N
9. Renderable FOG recycled ❑ N ❑ Y ❑ N ❑Y ❑ N
10. No chemical additives used my ❑ N � ❑ Y ❑ N ❑Y ❑ N
Non-Renderable FOG Disposal Location ❑ Trash W ontractor ❑ Other
Grease Interceptor Cleaner's Information -.,,Renderer's Information /�_ _
Name: - Q 0�\ C�1'T -e(PV1�Name: �1 CI.�-1 h�\1G,Y�c� LJ�'fG/ 1~I—
Address: ,QD 'till Q r• C)a k�S 1 Address: b Lo C!tA4 �-C• ; -t�vrt
Phone: Sf�yl"��' w 1\�6 r . U�) Phone:
Last Pump Date: PA A A
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