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RECEIVEID
2009
Grease Interceptor S •fig Worksheet Su�:�NC DEPnaT ENT
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Facility Name: 7�w6 0`t,
Date Submitted:—3-!-L` - B 9
NUMBER OF MEALS. SERVED AT PEAK HOUR A=
Based on the total number of seats and average time per meal .
Lounge and bar seating is counted at 20%.
WASTE FLOW RATE (Choose one) 16
• With Dishwashing Machine ...................... 6 gallon flow
• Without Dishwashing Machine ................ 5 gallon flow
• ,Single Service Kitchen* ............................. 2 gallon flow
• (Food Waste Disposer ....................... add 1 gallon flow)
RETENTION TUUES (Choose one) C =
• Commercial Kitchen Dishwasher ............. 2.5 hours
• Single Service Kitchen* ............................. 1.5 hours
STORAGE FACTORS (Choose one) D =
• Full Service Kitchen 0-12 hour operation:.......... 1
• Full Service Kitchen 12-20 hour operation:........ 2
• Full Service Kitchen 24 hour operation: ............. 3
• Single Service Kitchen* :...................................... 1.5
Minimum Interceptor Size (liquid capacity A x B x C x D= 17,( 0
*A single service kitchen refers to a restaurant where disposable dishware is used and
dishwashing operations are therefore greatly reduced.
Per City Ordinance 3401 the minimum sized Grease Interceptor permitted is
500 gallons.
Size Approved: Approved By: Date 5 O
retreatment Technician
A Grease Interceptor permit is required ($365.00 fee). Contact the
Pretreatment Technician (425-672-5755) if you have any questions or need help
with completing this form.
CITY OF EDMONDS
Grease Removal Equipment Application
Business Name: YlWWr LDate Submitted: 0�
Address• 3 f P,-P14A1- A,14Y 4jne9Mj5 1101 Suite No.:i_
Cdrw�w fi
Business Owner: �o,u 4m 64 i j G Mailing Address:
Contact Person/Title: VM6 0J �odl AlkMW I - L Phone: 465-YI, °
Days/Hours of Operation: — � i aq 62Cc (+6A91 /&CLf
Total Number of Meals Served Per Peak Hour (assume all seats filled):
Number of Seats: Dining: Lounge/Bar: Banquet Rooms: �z61)eck/Patio-
Buildin Occupancy Permit Capacity: Health Dept. Permit Capacity
ty
Inventory Kitchen Equipment and Plumbing Fixtures for this Establishment: (Grills,
burners, ovens, hoods, deep fat fryers, wok stations, soup kettles, sinks, pre -wash sinks,
dishwashers, disposers, mop sinks, floor drains, etc.) r
/YJ"t;p te 'r
What proportion, if any, of the dishware used is of the disposable type? �'c%lN C�wNA.
How is waste oil/grease handled, stored, and recycled/disposed? _a2c b inff'sTS
Estimate gallons of waste oil/grease produced per month: r
If recycled, by which company? k �1A _
How are vent hoods cleaned and where does the cleaning waste go?
Contact the Pretreatment Technician at 425-672-5755 to discuss the type and
size of equipment you must install, and then complete the appropriate
accompanying worksheet for either a Grease Interceptor or a Grease Trap.
[Rev. Feb. 20041