HomeMy WebLinkAboutBertucci's - 12/31/2020060
6{ZS153�01
FOR BOARD OF HEALTH USE ONLY Permit# Issued
FOOD ESTABLISHMENT PERMIT APPLICATION
(Application must be submitted at least 30 days before the planned opening date) 0'
Establishment Name 6 C'es ccC5
Establishment Address 0.),F-0
Establishment Mailing Address (if different) f55-
tV2_e_A6100r�3a
Establishment Telephone No
Applicant Name & Title:
Applicant Address 4/ -?®0 W 6(v'o(_v 0 1 d 7
Applicant Telephone No.: F'3 5-1-- a 5bo 24 Hour Emergency No.:
Applicant Email 6Z jj `5. C0 (A
Owner Name & Title (If different from applicant)
Owner Address
Owner telephone number
Owner email:
Establishment Owned By:
If a corporation or partnership, give name, title, and home address of officers or
An Association
partner.
IN A Corporation
Name Title Address
12 An Individual
a C-2 Ar �/ ✓�
F11 A Partnership
,Other legal Entity L_LC.
Person Directly Responsible For Daily Operations (owner, person in charge, supervisor, manager etc.)
Name & Title:
Address:
Telephone No: d7j®®rye 7 ' 24 Hour Emergency No: '7 a
FAX:
E-mail: °5 ° 4 r
Alt E -Mail: 0 6'rn 5. co 4't
District Or Regional Supervisor (if applicable)
Name & Title: t/ 4'e_
Address: /V 6 ®<
Telephone No: �� 24 Hour Emergency No:
FAX:
E-mail: /0 5-,
11
((a
Exhibit A
Bertucci's Restaurants, LLC - Officers and Directors
Liquor License holder for Bertucci's
State of Incorporation - FL Current
President Thomas Avallone Thomas Avallone
9211 Point Cypress Drive
Orlando, FL 32836
Secretary Jeffrey C. Sirolly Jeffrey C. Sirolly
1886 Meeting Place
Orlando, FL 32814
CFO Brian Connell Brian P. Connell
3 Patriot Lane
Whitman, MA 02382-2379
Assistant Secretary Christine A. Moscaritolo Christine A. Moscaritolo
70 LaGrange Street
West Roxbury, MA 02132
Food Establishment Information
WATER SOURCE: I V%/ /I
SEWAGE DISPOSAL: 4
No. of Food Employees:
DEP Public Water Supply No: (If applicable)
DAYS/HOURS: ItAon, W
Name of Person(s) In Charge Certified in Food Protection Management:
Name of Per on(s) In Charge Certified in Allergen Awareness Training
r
q t4DY iJ CCC
Name of pest control company routinely inspecting the premises for evidence of pests je-C)O
If there is seating for 25 people or more, a person trained in manual choke saving procedures will be onsite at all times
food is being prepared. Yes
Does this establishment require a FOG permit? If yes, please attach the FOG permit application.
Length of Permit:
Establishment Type:
X Annual
Retail Food $125.00
Mobile Food Consession
0 Temporary
Food Service up to 100 INCLUDING
NO PHF PREPARED ON SITE $100.00
FOOD TRUCKS $175.00
aL Manufacture Frozen Dessertstice Cream
Temporary Start Date:
Q Food Service up to 101 -200 $250.00
$25.00/freezer
Temporary End Date:
;KFood Service up to 201 + $300.00
0 Pushcart $50.00 # of Pushcarts:
Temporary Time:
(I Supermarkets $400'.'❑'I
Residential Kitchen $100.00
Rain Date:
Milk & Cream $10.00
Caterer $35.00
Food Operations: Definitions:PHF- Potentially hazardous food(fime/femperatum controls required)
(Check all that apply): Nan-PHFs- non -potentially hazardous food(not'me/temperature controls required)
RTE - ready -to -eat foods (Ex. sandwiches, salads, muffins which need no further processing)
Sale of Commercially Pre -Packaged Non-PHFs 5KPHFCooked To Order�'❑',
Hot PHF Cooked and Cooled or Hot Held
Sale of Commercially Pre -Packaged PHFs P' Preparation of PHFs For Hot And
for More Than a Single Meal Service
Delivery of Packaged PHFs Cold Holding For Single Meal Service
h 9
i] PHF and RTE Foods Prepared For Highly
Susceptible Population Facility
�a Sale of Raw Animal Foods Intended
Reheating of Commercially to be Prepared by Consumer
Use of Process Requiring A Variance
Processed Foods for Service Within 4 Hours
Customer Self -Service
and/or HACCP Plan (including bare hand
Customer Self -Service of Non PHF and Non-
contact alternative, time as a public health
Perishable Foods Only Ice Manufactured and Packaged for
control)
'❑"i Preparation of Non-PHFs Retail Sale
X Offers Raw Or Undercooked Food.,Qf
Juice Manufactured and Packaged for
Animal Origin (j
Other Food Operations Retail Sale
0 Vacuum Packaging !Cook Chill
Offers RTE PHF in Bulk Quantities
N Prepares Food1Single Meals for
Retail Sale of Salvage, Out -Of -Date
Catered Events or Institutional Food Service
or Reconditioned Food
I, the undersigned, attest to the accuracy of the information provided in this application and affirm that the food
establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been Ducted by the
board of health on how to obtain copies of 105 CMR 590.000 and the federal Food Code.
Signature of Applicant:
Pursuant to MGL Ch.62C, sec. 49A, I certify under the penalties i
and paid state taxes required under law.
Social Security Number or Federal ID: r ®�
Signature of Individual or Corporate Name: )d
G
I, to my beesiknowledge and belief, have fled all state tax returns
TAX CERTIFICATION FORM
I certify under the penalties of perjury that I, to my best knowledge and
belief, have filed all state tax returns and paid all state taxes required
under law.
Signature of Individual or Corporate Name By: C4o+q Offi#r (Mandatoni, if Applicable)
13 - 0 ? 1�7 5 16-11
**Social Security No. (Vohmtanj) or Federal
Identification Number
*This license will not be issued unless this certification clause is signed
by the applicant.
** Your social security number will be furnished to the Massachusetts
Department of Revenue to determine whether you have met tax filing or
tax payment obligations. Licensees who fail to correct their non -filing or
delinquency will be subject to license suspension or revocation. This
request is made under the authority of Massachusetts General Law
Chapter 62C, section 49A.
C:\Users\sleite\Desktop\Scott's Documents\Food Establishments- Temp\TAX CERTIFICATION FORM.doc
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
Business/Organization Name: tY6 e4tu'- C i C
Address: ZCA CD 4D <.-- -5
me#: "aCn< ` 37/
Are you
an employer? Check the appropriate box:
Business Type (required):
1. X
I am a employer with employees (full and/
5. ❑ Retail
or part-time).*
6. X Restaurant/Bar/Eating Establishment
2. ❑
I am a sole proprietor or partnership and have no
7, ❑ Office and/or Sales (incl. real estate, auto, etc.)
employees working for me in any capacity.
g. ❑ Non-profit
3. ❑
[No workers' comp. insurance required]
We are a corporation and its officers have exercised
9. ❑ Entertainment
their right of exemption per c. 152, § 1(4), and we have
10. ❑ Manufacturing
no employees. [No workers' comp. insurance required]*
11.❑ Health Care
4. ❑
We are a non-profit organization, staffed by volunteers,
12.❑ Other
with no employees. [No workers' comp. insurance req.]
*Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information.
**If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an
organization should check box #1.
I am an employer that isproviding workers' compensation insurance for my employees. Below is the policy information.
Insurance Company Name:_ n7i iocPT� l� , A1I (- k.:2 !'r n L!] S U F j Cl/ C d
Insurer's Address: C.i 15� ` z
City/State/Zip: �1 G / LG c LL- Z)<� (,
Policy # or Self -ins. Lic.
Attach a copy of the workers' compensation ren
Se ion 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ent, as well as civil penalties in the form of a STOP WORK ORDER and a fine
Be advised that a copy of this statement may be forwarded to the Office of
3 — <� I Expiration Date: �4t/ 0-;2- d
declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under
fine up to $1,500.00 and/or one-year lmprls
of up to $250.00 a day against the violat
Investieations of the DIA for insuranc cove
I do herebycrrtify, (
under the pat andpenalties ofperjury that the information provided aboveis true and correct
r , T)mw Hodn d 6
Official
City or
not write in this area, to be completed by city or town official
Issuing Authority (circle one):
1. Board of Health 2. Building Department
6. Other
Contact
Permit/License
3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office
www,mass.gov/dia
Phone
Page 1 of 1
A L? CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
07/31/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Willis of Connecticut, LLC
c/o 26 Century Blvd
P.O. Box 305191
CONTACT
NAME:
PHONE1-877-945-7378 FAC No; 1-888-467-2378
E�MA LE
ADORESS: certificates@Willie. com
INSURERS AFFORDING COVERAGE NAIC#
Nashville, TN 372305191 ,USA
INSURER A: Enrich American Insurance Company 16535
INSURED
INSURERS: American Guarantee and Liability Insurance 26247
INSURER C:
Bertucci's Restaurants, LLC
4700 Nillenia Boulevard, Suite 400
Orlando, FL 32839
INSURER D:
INSURERS:
INSURER F
1vcly Gia yr ...——.._.. ...
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTRINSD
TYPE OF INSURANCE
ADOL
BURR
WD
POLICYNUMBER
POLICY EFF
UP
MMIDD
LIMITS
AUTHORIZED REPRESENTATIVE
X COMMERCIAL GENERAL LIABILITY
v �
EACH OCCURRENCE $ 2,000,000
DAMAGE TO RENTED 100,000
PREMISES Ea occurrence $
CLAIMS -MADE � OCCUR
MED EXP(Anyone person) $ 5,000
A
X RETENTION: $350,000
GM 8376989-17
07/01/2019
07/01/2020
PERSONAL S ADV INJURY $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE $ 10,000,000
PRODUCTS-COMPIOPAGG It 2,000,000
X POLICY ❑ PECT RO- FILOC
PER LOCATION AGG $ 2,000,000
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident $ 1,000,000
BODILY INJURY (Per parson) $
X ANYAUTO
BODILY INJURY (Per accident) $
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTO, ONLY
BAP 8376990-17
07/01/2019
07/01/2020
PROPERTY DAMAGE $
Per accident
B
X
UMBRELLALIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
AUG 6548039-10
07/01/2019
07/01/2020
EACH OCCURRENCE $ 25,000,000
AGGREGATE $ 25,000,000
DEO RETENTION
$
WORKERS COMPENSATION
_
X STATUTE ERH
A
AND EMPLOYERS' LIABILITY YIN1,000,000
ANYPROPRIETORIPARTNERWEXECUTIVE No
OFFICEREMBER (MEXCLUDED?
(Mandatory In NH)
If yes, descdbeunder
DESCRIPTION OF OPERATIONS below
NIA
WC 7969103-01
07/01/2019
07/01/2020
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE POLICY LIMIT $ 1,000,000
A
Liquor Liability
GLO 8376989-17
07/01/2019
07/01/2020
Aggregate: $2,000,000
Each Common Cavee: $1,000,000
SIR: $250,000
DESCRIPTION OF OPERATIONS/ LOCATIONS I VeHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
This Voids and Replaces Previously Issued Certificate Dated 07/01/2019 WITH ID: W11920469.
Re: Evidence of Insurance
liGRlll'IYf111::. Ilv�v�,�
-"'
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Bextucci's Restaurants, LLC
155 Otis Street
Noxthborough, MA 01532
v �
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Ss ID: 18327942 secs: 1305966
Town of Mansfield Health Department
APPLICATION FOR FATS OILS and GREASE DISCHARGE PERMIT
RESTAURANT& FOOD PREPARATION ESTABLISHMENTS
Business/ Food Establishment Name:
Mailing Address: 5 C C! f fc1C>t
Phone/Fax Number: — C;? rl�'I ^ }a /
Email:
Contact Person/Title for Grease
Name of Company scheduled to pump internal grease trap(s) monthly: a. C; c J� 14 e-
Name of Company scheduled to pump external grease trap quarterly:
Please attach the following documents to this application:
• Most recent waste hauler receipt or waste hauler manifest
• Appropriate permit fee based on new fee schedule (Checks can be made out to the Town of
Mansfield)
Food Establishments
Fee
3 grease interceptors/traps or less and/or 1 yellow grease collection
container
$50
Each grease interceptor/trap over 3
$50 ($200 max)
I THE UNDERSIGNED HAVE OBTAINED AND REVIEWED THE MANSFIELD BOARD OF HEALTH FATS, OILS, AND
GREASE (FOG) REGULATIONS APPROVED AND ADOPTED ON OCTOBER 4, 2018.
In considerate of the granting of the permit, the undersigned agrees to the conditions of the permit
and ackno7@dgps that the information submitted in these documents is true, accurate and complete.
Date /off?/tai
Print
Facility Onerational Information
Please answer all questions in this section. If an item is not applicable, indicate "N/A". Unless otherwise
specified, please print or type.
Seating Capacity (per Fire Department Regulation):
N
Seating Capacity (Actual Count): O.' C;t 0
Normal Hours of Food Preparation/Service:
Monday
Thursday
Sunday 11,4
Tuesday 2,4 - ag
Friday ?,4�- — (I
Wednesday 74 —, to
Saturday -74 -- j(
Please indicate the NUMBER of kitchen fixtures used in your establishment and if it is attached to a Grease
Removal Units (GRU/trap)
Number in
establishment
Attached to
GRU
3 compartment sink
Handwashing sink
Commercial Dishwasher
Bar sink
Mop Sink
Garbage Disposal
Ice Making Machines
Fryolators
Grills or Ovens
Exhaust Hoods
125
Floor drains
Other:
How are hood vents cleaned? (i.e., in three (3) bay sink, off site by private company):
Is dinnerware pre -rinsed before being washed? X' Yes
If yes, at what station/sink? D 1,5 A �
Ian
Grease Trans and Grease Removal
Internal Grease Traps
How many Indoor Grease Removal Units (GRU/trap) are on site?
Please list fixtures attached to each grease trap
Grease Trap 1 3
Grease Trap 2
Grease Trap 3
Grease Trap 4
Grease Trap 5
External Grease Traps
Does this establishment have an outdoor Grease Removal Unit (GRU/Interceptor)?
XYes 0 No Size galloons
Where is the existing outdoor GRU located? �iG,exN�f! a1
If the owner is responsible for external trap pumping, provide the Name, Address and Telephone Number of
the property owner below:
Property Owner's Name: _
Property Owner's Address:
Property owner's Telephone Number:
Yellow Grease Waste
Do you store yellow grease waste from fryolators? 7 A
Where is the grease storage unit loco
How often is this grease storage u nit
Please list the vendor who removes the waste: IV I
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Christopher George
From: Chrissy Wills <cwills@bertuccis.com>
Sent: Thursday, December 5, 2019 7:36 AM
To: Christopher George
Subject: FW: Fats Oil Grease (FOG) regulations
Hi Chris,
Sorry for the delay! Appears to just be 1 internal grease trap, and it's at the 3 Bay Sink. O
Chrissy "WiCCs
Operations & Licensing Coordinator
RerWWff
BRICK OVENPIZZAPASTA
155 Otis Street, Northborough, MA 01532 1 Bertuccis.com
o: 508-351-2562 e: cwills(o)bertuccis.com
From: Mansfield Crossing - 129
Sent: Wednesday, December 4, 2019 6:26 PM
To: Chrissy Wills
Subject: RE: Fats Oil Grease (FOG) regulations
3 bay sink
From: Chrissy Wills
Sent: Wednesday, December 04, 2019 3:53 PM
To: Suzette Landry; Mansfield Crossing - 129
Subject: RE: Fats Oil Grease (FOG) regulations
Thanx, but is it at dishwasher or 3 bay sink?
Chrissy -WiC&
Operations & Licensing Coordinator
Be1•ww' `
BRICK OVEN PIZZA A PASTA
155 Otis Street, Northborough, MA 01532 1 Bertuccis.com
o: 508-351-2562 e: cwills(aDbertuccis.com
From: Suzette Landry
Sent: Wednesday, December 4, 2019 3:44 PM
To: Chrissy Wills
Subject: FW: Fats Oil Grease (FOG) regulations
From: Mansfield Crossing - 129
Sent: Wednesday, December 4, 2019 3:43 PM
To: Suzette Landry
Subject: RE: Fats Oil Grease (FOG) regulations
We only have one... SORRY
From: Suzette Landry
Sent: Wednesday, December 04, 2019 2:49 PM
To: Mansfield Crossing - 129
Subject: FW: Fats Oil Grease (FOG) regulations
Making sure someone answered this??
From: Chrissy Wills
Sent: Monday, December 2, 2019 2:25 PM
To: Christopher George
Cc: Mansfield Crossing - 129; Suzette Landry
Subject: RE: Fats Oil Grease (FOG) regulations
Hi Team Mansfield,
Can someone please confirm how many internal grease traps you have? Thanx! O
Chrissy 1NiCCs
Operations & Licensing Coordinator
BerWcueavyff
4NICK OVEN PIZZA A PASTA
155 Otis Street, Northborough, MA 01532 1 Bertuccis,com
o: 508-351-2562 e: cwills(a)bertuccis.com
From: Christopher George [mailto:cgeorge@mansfieldma.com]
Sent: Monday, December 2, 2019 2:21 PM
To: Chrissy Wills
Subject: FW: Fats Oil Grease (FOG) regulations
Hi Chrissy,
We're just looking for an update on this.
Thank you,
-Chris George
Administration Assistant
Public Health Department, Town of Mansfield
508-261-7366, Ext. 66463
From: Chrissy Wills [mailto:cwills@bertuccis.com]
Sent: Monday, October 28, 2019 1:37 PM
To: Amy Donovan -Palmer; Mansfield Crossing - 129
Subject: RE: Fats Oil Grease (FOG) regulations
Hi Bill,
Can you please confirm? Thanx! O
Chrissy WiCCS
Operations & Licensing Coordinator
IleducC1
BRICK OVEN PIZZA t PASTA
155 Otis Street, Northborough, MA 01532 1 Bertuccis.com
o: 508-351-2562 e: cwills bertuccis.com
From: Amy Donovan-Palmer[mailto:adpalmer@mansfieldma.com]
Sent: Monday, October 28, 2019 1:33 PM
To: Mansfield Crossing - 129; Chrissy Wills
Subject: RE: Fats Oil Grease (FOG) regulations
Hello,
Thanks again for this information. The application says there is a trap for the dishwasher and a trap for the 3 bay sink. I
only have information for the 3 bay sink. Could you clarify for my records how many internal traps are located at
Bertuccis?
Thanks,
Amy
From: Mansfield Crossing - 129 [mailto:bert129@bertuccis.com]
Sent: Tuesday, October 22, 2019 12:42 PM
To: Chrissy Wills
Cc: Amy Donovan -Palmer
Subject: FW: Fats Oil Grease (FOG) regulations
From: Mansfield Crossing - 129
Sent: Thursday, October 03, 2019 3:46 PM
To: 'Amy Donovan -Palmer'
Cc: Chrissy Wills
Subject: RE: Fats Oil Grease (FOG) regulations
Hello Amy,
Here is our log and receipt's
Have a great day,
Bill
From: Amy Donovan-Palmer[mailto:adpalmer@mansfieldma.com]
Sent: Thursday, October 03, 2019 2:21 PM
To: Amy Donovan -Palmer
Cc: Christopher George
Subject: FW: Fats Oil Grease (FOG) regulations
Importance: High
Hello all,
Just a friendly reminder that FOG reports for June, July and August are due this Tuesday, October 8th. Please send the
onsite log which lists the percent of combined grease and solids, along with a receipt from the pumping company.
Also, on October 21, 2019, from 10:30-12:30, Mansfield Health Department will be hosting a Fats, Oil, Grease class open
to all food service establishments and grease trap pumpers interested in learning about the local Mansfield FOG
regulations, regulation requirements, and proper FOG system maintenance, including trap cleaning. Please email the
Health Department at health(a)mansfieldma.com no later than October 14`h to reserve your spot.
Contact the Health Department with any questions.
Thank you,
Amy
Amy Donovan -Palmer, MPH, RS
Health Agent
6 Park Row
Mansfield, MA 02048
Phone: 508-261-7366
From: Amy Donovan -Palmer
To: Amy Donovan -Palmer
Subject: Fats Oil Grease (FOG) regulations
RE: Fats Oil Grease (FOG) regulations
Please note the following requirements apply to all food establishments. Current regulations are attached for your
reference.
• Indoor traps must be inspected, serviced and cleaned at least monthly by a professional drain cleaner, licensed
plumber or Permitted Offal/Septage Hauler.
• Outdoor/Underground Grease Interceptor must be pumped, inspected and serviced by a Permitted
Offal/Septage Hauler at least every three (3) months or at a frequency deemed necessary to prevent any
potential blockage.
• A copy of "The Grease Trap Maintenance Log" shall be kept onsite and properly maintained relative to the
operation/maintenance of any FOG Pretreatment System.
• Any waste grease and oil (i.e. yellow grease) must be stored in an appropriate container on an impervious
surface, such as concrete or pavement, and in a sheltered area to prevent entry of precipitation and vermin. The
container must be sealed and the surrounding area must be kept in sanitary conditions at all times. The
container must be collected by an approved vendor.
At this point, the BOH is requesting the following information be sent to the Health Department:
• By April 8th, 2019, January, February and March pumping records and a copy of the grease trap maintenance log
• By July 8th, 2019, April, May, and June pumping records and a copy of the grease trap maintenance log
• By October 8"', 2019, July, August and September pumping records and a copy of the grease trap
maintenance log
• By January 8th, 2020, October, November, and December pumping records and a copy of the grease trap
maintenance log
A sample maintenance log is attached for your use.
Please contact the Health Department if we can be of any additional assistance.
Thankyou,
Amy
Amy Donovan -Palmer, MPH, RS
Health Agent
Town of Mansfield
6 Park Row
Mansfield, MA 02048
508-261-7366
Disclaimer
The information contained in this communication from the Town of Mansfield is confidential. It is intended solely for use by the
recipient and others authorized to receive it. If you are not the recipient, you are hereby notified that any disclosure, copying,
distribution or taking action in relation of the contents of this information is strictly prohibited and may be unlawful.
This email has been scanned for viruses and malware, and may have been automatically archived by Mimecast Ltd, an innovator in
Software as a Service (SaaS) for business. Providing a safer and more useful place for your human generated data. Specializing in;
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Disclaimer
The information contained in this communication from the Town of Mansfield is confidential. It is intended solely for use by the
recipient and others authorized to receive it. If you are not the recipient, you are hereby notified that any disclosure, copying,
distribution or taking action in relation of the contents of this information is strictly prohibited and may be unlawful.
This email has been scanned for viruses and malware, and may have been automatically archived by Mimecast Ltd, an innovator in
Software as a Service (SaaS) for business. Providing a safer and more useful place for your human generated data. Specializing in;
Security, archiving and compliance. To find out more Click Here.
Disclaimer
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