HomeMy WebLinkAboutHarry's Place FOG only - 12/31/2021I0-1 -5o.
Town of Mansfield Health Department
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Business/ Food Establishment Name: AVI' 1 5
Mailing Address:
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Phone/Fax Number:
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Contact Person/Title for Grease Tra
Name of Company scheduled to pump internal grease trap(s) monthly: /U✓� ���
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
$50
container
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 consideration of the granting of the permit, the undersigned agrees to the conditions of the permit
and acknowledges that the information submitted in these documents is true, accurate and complete.
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Signed Aj A&= Date 6he-91
Print Name tjf(f/
Facility Operational 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):
Seating Capacity (Actual Count):
Normal Hours of Food Preparation/Service:
Monday _s" /0110 Tuesday Wednesday
Thursday 0 0 Friday S I C U Saturday
Sunday
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
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Mop Sink
Garbage Disposal
Ice Making Machines
Fryolators
Grills or Ovens
I
Exhaust Hoods
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? Yes No
If yes, at what station/sink?
2
Grease Traps 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
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)?
Yes [/ No Size -00 gallons
Where is the existing outdoor GRU located?
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?
Where is the grease storage unit located?
How often Is this grease storage unit emptied?
Please list the vendor who removes the waste: