HomeMy WebLinkAboutFood Service Establishment Inspection 50 � ovi 14 8 <
C `
Town of South Windsor
sox•coN HEALTH DEPARTMENT/WATER POLLUTION CONTROL
Inspection Checklist
Date: 10
Inspector: S
Establishment: ' U !n
Address: U v2 W
Contact Name: Signature:
Phone: la
INTERCEPTOR NUMBER
General Information #1 #2 #3
1. Was grease interceptor inspected vA' ❑ N ❑ Y ❑ N ❑Y ❑ N
2. Grease interceptor accessible for maintenance u,-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. m/Y ❑N ❑ Y ❑ N ❑Y ❑ N
2. Provided written contractor invoice for last cleaning PX ❑ N ❑ Y ❑ N ❑Y ❑ N
3. Date of last cleaning
t� ❑ Y ❑ N ❑ Y ❑ N ❑Y ❑ N Q
❑ Y ❑ N ❑ Y ❑ N ❑Y ❑ N
Major Violations Indoor Grease Interceptor
1. Unit maintained daily ❑ Y ❑,K ❑ Y ❑ N ❑Y ❑ N
2. Unit energized,and automatic timer set to [a/y ❑ N ❑ Y ❑ N ❑Y ❑ N
operate during business hours.
3. Screening basket in place Zy ❑ N ❑ Y ❑ N ❑Y ❑ N
4. Skimmer in working order E/y ❑ N ❑ Y ❑ N ❑Y ❑ N
5. Heater in working order V� ❑ N ❑ Y ❑ N ❑Y ❑N
6. Grease collection container in place w/� ❑ N ❑ Y ❑ N ❑Y ❑N
Minor Violations
4. Grease interceptor maintenance log available ply ❑ N ❑ Y ❑ N ❑Y ❑ N
5. Signs posted at all sinks ❑ Y 2-IT ❑ Y ❑ N ❑Y ❑ N
6. Pots,pans,dishes,and utensils scraped nelf ❑ N ❑ Y ❑ N ❑Y ❑ N
7. Adequate renderable FOG container storage Q/� ❑ N ❑ Y ❑ N ❑Y ❑ N
8. Exhaust hood properly cleaned W� ❑ N ❑ Y ❑ N ❑Y ❑ N
9. Renderable FOG recycled G;,V ❑ N ❑ Y ❑ N ❑Y ❑ N
10. No chemical additives used sr'� ❑ N ❑ Y ❑ N ❑Y ❑ N
Non-Renderable FOG Disposal Location ❑ Trash &C;ontractor ❑ Other
Grease Interceptor Cleaner's Information Renderer's Information
Name: S ,*4 _ Name:
Address: �/� �1�Q/�(�. �Mf� Address:
Phone:�"1 `J ` `` o \�_ Phone:
Last Pump Date: '�A l 1�`��