GREASE AND OIL PERMIT PROGRAM (FOG)

Grease and Oil Permit Application (to be renewed annually) One time Permit Fee - $225.00

Instructions: Provide the appropriate information for all fields denoted as required . Incomplete applications will NOT be accepted by the District until all required information is provided.

Application Type: (Select all that apply) (required)

Initial Application

Renewal Application

Change of Ownership/Permit Modification

No Change

Applicant: (required)

Applicant Mailing Address: (required)

Authorized Representative Name: (required)

Email Address: (required)

Facility Name and Address: (required)

Facility Phone Number: (required)

Facility Email Address: (required)

Hours of Operation: (required)

Date Business Opened or Anticipated Date of Opening: (required)

List major equipment used for food preparation (e.e., grills, fryers, dishwashers, sinks, etc. ) Specify type and Size/Specifications: (required)

Number of Grease Interceptors and/or Traps: (required)

Date of Installation: (required)

(1) - Location (required)

(1) - Size (in gallons) (required)

(1) - Type: (Check one) (required)

Grease Interceptor

Grease Trap

(1) - Service Frequency (required)

(2) - Location (required)

(2) - Size (in gallons) (required)

(2) - Type: (Check one) (required)

Grease Interceptor

Grease Trap

(2) - Service Frequency (required)

Grease Hauler Information: Only District approved grease haulers should be entered into this section. Give information on how grease is disposed of. If it is to be removed from interceptor by grease hauler, give information on how they dispose of it. If it is removed by you or identified employee, give receptacle information and party or parties responsible.

Name of Hauler: (required)

Address of Hauler: (required)

Phone No. of Hauler: (required)

Email address of Hauler: (required)

Describe how grease/oil is disposed of (i.e., landfill by waste hauler, recycled, pumped, etc. If you dispose of the grease/oil yourself, indicate location and procedure for disposal: (required)

Signatory Requirement - This MUST be signed by a Company/Business Authorized Representative:

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this application, and affirm that the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information. I certify that upon approval of the permit, this establishment's operation and its resultant wastewater discharge will achieve consistent compliance with the District's Regulations.

Name/Title of Authorized Representative (required)

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

**Please be aware that per Fountain Sanitation District's Regulations, the District has the right to inspect the facility at any time, with or without prior notice, to ensure that all requirements of the Grease and Oil Permit Program and all other federal, State, and local wastewater discharge requirements are being met.

Note: This application is a requirement of your Permit. Permit holders agree to abide by all Rules, Regulations and Ordinances of the District concerning Permit use. Any violation of the District Rules, Regulations and Ordinances regarding the use of a Sewer Interceptor Waste Discharge Permit can subject the Permit to immediate revocation as determined by the District. Permits are non-transferrable. Upon change of legal Owner or responsible party or material change of the interceptor or discharge quality or quantity, a new Permit application shall be submitted. Permits shall be kept on site at the permitted facility and must be available for District personnel to view. The information provided herein is not confidential in nature and can be shared with the public.

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