Wastewater Division

1. GENERAL INFORMATION
Name of Facility   

Contact Person      

Physical Address   

Mailing Address     

Phone Number       

Fax Number            

E-mail Address      

2. OWNERSHIP
Owner Name                 

Contact Person              

Mailing Address             

Phone Number               

OUC Account #                             
*Note: This is a required field.

OUC Customer Name:                   
Please provide customer name exactly as it appears on your bill.

Fax Number                  

Owner E-mail Address  

3. FACILITY TYPE
Facility Type   Restaurant Food Processor Other

If Other, please specify 

4. HOURS OF OPERATION
Hours of Operation - Weekdays 

Hours of Operation - Weekends  

5. CUISINE TYPE
Type of Cuisine 

6. STRUCTURE TYPE
Type of Structure  Existing Facility New Facility (Construction) Remodeled Facility Freestanding Facility Attached Facility

7. SEATING CAPACITY
Seating Capacity  persons

Is seating capacity defined by the Fire Department? yes no

8. EXPANSION PLANS
Is future expansion planned?  yes no

If yes, please describe..

.

9. NUMBER OF MEALS
Approximate average number of meals served per day

Busiest days of the week Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Average number of meals served on these days

10. TYPE OF DISHES/UTENSILS  Washable Disposable Both

11. KITCHEN EQUIPMENT
Cookers_____________________________________________
                                                             SIZE / DRAIN SIZE
Fryer                   yes no           

Charbroiler           yes no          

Grill                     yes no         

Stove                   yes no         

Oven                    yes no         

Oven Broiler          yes no         

Wok Stove            yes no         

Other                    yes no         

Sinks_______________________________________________
3-Compartment      yes no         

Hand                     yes no         

Vegetable              yes no         

Mop                      yes no         

Other                    yes no         

Other Equipment_______________________________________
Garbage Disposal   yes no         

Walk-in Cooler       yes no         

Dishwasher            yes no         

Other                     yes no         

12. FOOD PREPARATION
Pre-cooked Foods       Off-Site Prepared Foods 

Frozen Foods             Fresh Produce  

Canned Foods            Grilled or Baked Meats  

Fried Foods                Baked Goods 

Wok Foods                Catered Foods  

13. POLLUTION PREVENTION PROCEDURES
Briefly explain clean-up procedures. (For example, pots and pans are cleaned in a dishwasher.)

14. RECYCLING
Do you recycle spent oils & grease?    yes no 

If yes, briefly explain the program and the grease handling procedures, including information on equipment.

If not, do you have plans to initiate one?   yes no 

If yes, what is the proposed schedule? 

15. GREASE MANAGEMENT DEVICES         SIZE / DRAIN SIZE
Grease dumpster     yes no              

Grease interceptor    yes no             

Under the sink trap  yes no              

Recycle holding tank   yes no          

Oil/Water seperator      yes no         

Plumbing fixtures          yes no         

16. COMMON GREASE INTERCEPTOR
If you are located in a retail center, it is possible that more than one facility in the retail center may be connected to a common grease interceptor.  Do you share a grease interceptor with other facilities?
yes no 

If you share a common interceptor, who owns the facility or is responsible for the maintenance? 

17. ADDITIVES.
Are you currently introducing any additives into your system such as bacteria or enzymes?
yes no 

18. CONSTRUCTION DOCUMENTS *for new construction
Please provide the City a copy of the "As-Builts" plans, including the specifications, the facility layout (site plan), O&M procedures for the grease interceptor, installation instructions for grease handling equipment, and complete plumbing diagrams (schematics) showing the plumbing fixture(s) connected to the new waste piping system with the flow direction indicated.

19.CERTIFICATION STATEMENT
By typing your name in the box provided below, you are certifying that the information provided for the User Information Survey, to the best of your knowledge, is accurate and complete. You understand that the User Information Survey serves as the application for issuance of the Registration Certificate for the City of Orlando Oil & Grease Management Program. You further understand that falsification of this information is a violation of the City of Orlando Code, and as such, become subject to enforcement actions and penalties as set forth in the City Code.

Type name here