Food Service Establishment Permit Application

Transcription

1 Pinellas County Department of Environment and Infrastructure Water & Sewer Division, Grease Management Program Food Service Establishment Permit Application SECTION A: INTRODUCTION Pinellas County s Grease Ordinance, Section , requires any food service establishment generating grease waste within the retail or wholesale service area of Pinellas County must obtain a Food Service Establishment Permit from Pinellas County. A food service establishment is defined in Section of the Grease Ordinance as: Food service establishment (FSE). Establishments which prepare and/or package food or beverages for sale or consumption, on or off-site, with the exception of private residences. Food service establishments shall include, but are not limited to: food manufacturers, food packagers, restaurants, grocery stores, bakeries, lounges, hospitals, nursing homes, churches, schools and all other food service establishments not listed above. Requirements for food service facilities include weekly cleanings of grease traps and a monthly complete pump out of grease interceptors. You must complete and return the Food Service Establishment Permit Application along with a check (made payable to Pinellas County Utilities) for: [ ] $ if you have a grease trap or [ ] $ if you have a grease interceptor Return the completed application within ten (10) days, (DATE: ) including the following: 1. Check 2. Copy of water bill 3. Copy of plumbing floor diagram 4. Copy of menu 5. Copy of last pump out receipt (refer to page 6) Mail the completed application and check to: Pinellas County DEI, Water and Sewer Division Grease Management Program 1620 Ridge Road, Bldg. A Largo, FL FAILURE TO SUBMIT AN APPLICATION MAY RESULT IN FINES. If you have any questions about any of the requirements of this Ordinance, please call the Grease Management Program at (727) , or go to our website at Pinellas County Department of Environment & Infrastructure Water & Sewer Division Grease Management Program Page 1 of 6

2 SECTION B: GENERAL INFORMATION Enter the establishment s official or legal name. Provide the physical location of the establishment that is applying for a discharge permit. 1. Establishment Name: Establishment Street Address: Phone Number: Website: Provide the business mailing address (if different from above) where correspondence (including invoices) from Pinellas County should be sent. Note: Location must be able to accept Certified Mail (may not use P.O. Box). 2. Name: Street: Phone Number: Designated Contact for the Establishment: Provide the name and telephone number of the person who is: Familiar with the operation of the establishment (e.g. the owner or manager) Is authorized to sign for the establishment for the purposes of signing applications and reports Can be contacted by Pinellas County if enforcement actions are ever deemed necessary This person will receive correspondence from the Grease Management Program including the Permit. 3. Designated Establishment Contact: Name: Title: Phone Number: Pinellas County Department of Environment & Infrastructure Water & Sewer Division Grease Management Program Page 2 of 6

3 Provide the following information of the property owner (if different than facility): 4. Property Owner s Name: Property Owner s Address: Phone Number: SECTION C: WATER SUPPLY 1. Name as it appears on water bill: Mailing Address (for water bill): 2. Water Service Account Number(s): * Attach a copy of your most recent water bill Or Indicate if Landlord pays water bill [ ] SECTION D: FACILITY OPERATIONAL CHARACTERISTICS 1. Please choose one description that best describes your facility: [ ] Fast Food Restaurant [ ] Nursing Home / ALF [ ] Full Service Restaurant [ ] Hotel / Motel [ ] Drive Through (only) Restaurant [ ] School [ ] Seasonal Restaurant [ ] Club / Organization [ ] Coffee Shop [ ] Company / Office Building [ ] Bakery [ ] Ice Cream Shop [ ] Supermarket [ ] Hospital [ ] Religious Institution [ ] Other Pinellas County Department of Environment & Infrastructure Water & Sewer Division Grease Management Program Page 3 of 6

4 2. What is the seating capacity at your facility? 3. What are the days and hours of operation? 4. Please indicate the equipment and quantity of each item that you have in the food preparation, cooking and cleanup area of the facility. If none, denote with a zero. [ ] Grill [ ] Tilt Kettle/Crock Pot [ ] Oven [ ] Garbage Disposal [ ] Dishwasher [ ] 3-Bay Pot Sink [ ] Pre-rinse Sink [ ] 2-Bay Pot Sink [ ] Mop Sink [ ] Singe Bay Sink [ ] Deep Fryer [ ] Hand Sink [ ] Floor Drains [ ] Other Equipment 5. Provide a copy of the indoor and outdoor plumbing floor diagrams, which should include the location of all water meters, facility sewer connections, grease interceptors, sinks, floor drains, dishwashers, restrooms, etc. (If a plumbing floor diagram is not available, a blueprint of the facility, evacuation route map or hand drawn diagram showing those items above may be substituted). SECTION E: WASTEWATER DISCHARGE INFORMATION 1. Please check the item which best describes your current wastewater discharge. [ ] Existing Sewer Discharge [ ] Existing Septic System [ ] Proposed (new) Sewer Discharge 2. Are there any changes or expansions planned in the next year that could alter the wastewater volumes or characteristics? [ ] Yes [ ] No 3. If yes to question 2 above, briefly describe these changes and their effects on the wastewater and volume characteristics. (Attach additional sheets if needed.) Pinellas County Department of Environment & Infrastructure Water & Sewer Division Grease Management Program Page 4 of 6

5 SECTION F: TREATMENT DEFINITION: Grease traps/interceptors are plumbing devices designed to intercept most grease and solids before they enter a wastewater disposal system. Grease Trap: Generally located under the kitchen sink, capacity is 50 gallons or less. Grease Interceptor: Generally located underground, capacity is over 50 gallons. 1. This facility has a: [ ] Grease Trap [ ] Grease Interceptor [ ] Both [ ] Other Pretreatment Device [ ] None [ ] Unknown 2. Complete the following for all grease traps/interceptors. Make and model, if not known, then put unknown in the space provided. Include the location and capacity of the interceptor, if the exact capacity is not known, then provide your best guess as to the size of the grease interceptor (in gallons). Number of grease traps/interceptors: Make and Model: Location (kitchen, parking lot, etc.): Capacity of grease trap/interceptor (in gallons): Make and Model: Location (kitchen, parking lot, etc.): Capacity of grease trap/interceptor (in gallons): 3. If the grease trap is being maintained on-site, how do you dispose of the waste after cleaning? [ ] Trash [ ] Contractor disposes of grease [ ] Recycle [ ] Other: Pinellas County Department of Environment & Infrastructure Water & Sewer Division Grease Management Program Page 5 of 6

6 4. If a contractor(s) cleans the grease trap/interceptor(s), please list the following: Contractor Name: Address: City: State: Zip: Phone Number: 5. How often is the grease trap/interceptor being cleaned / pumped? 6. Date of last cleaning/pump out: * Attach a copy of the last pump out receipt SECTION G: CERTIFICATION I certify under penalty of law that the information submitted in this application is, to the best of my knowledge and belief, true, accurate and complete. I agree to abide by the regulations contained in the Pinellas County Code, Section through , as well as any other applicable Federal, State or Local regulations. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Name: Title: Signature Date Pinellas County Department of Environment & Infrastructure Water & Sewer Division Grease Management Program Page 6 of 6