19F - RECEIVE AND FILE SEWER SYSTEM

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Floor Sinks With Cookina Eauinment Type Location Qtv / Qtv Missing Screens ❑ Floor Sinks With Wok(s) Cooking Area / ❑ Floor Sinks With Kettle(s) Cooking Area / ❑ Floor Sinks With Other Cooking Area / Cooking Equipment Floor Drains and Other Floor Sinks Type Location Qtv / Qtv Missing Screens Common Drains Food Prep/Rinse/Dish-wash Area / Common Drains Cooking Area / Floor Sinks without Equip Food Prep/Rinse/Dish-wash Area / Floor Sinks without Equip Cooking Area / Floor Sinks without Equip Other Areas / X. Grease Removal Devices Grease Interceptor ❑ Yes ❑ No If not, is there space available? ❑ Yes ❑ No ❑ Interceptor Shared with (FSEs): Distance from kitchen area Location Manufacturer Model Size (Gallons) ❑ Estimated ❑ Documented Dimensions (Inches): Length Width Fluid Depth Access Depth (grade to interceptor base) Date Installed Number of Lids (Excluding Sample Box Lid) ❑ 1 ❑ 2 ❑ 3 ❑ 4 Sample Box ❑ Yes ❑ No Baffle Tees Checked ❑ Yes ❑ No Pumper Name Pumping Frequency ❑Monthly ❑Quarterly ❑Semi -Annually ❑Annually ❑Other Grease Trap ❑ Yes ❑ No If not, is there space available? ❑ Yes ❑ No ❑Passive ❑Automatic Fixtures Connected Manufacturer Model Size (Gallons) Dimensions (Inches): Length Width Date Installed Baffle Tees Checked ❑ Yes ❑ No Baffle Tees Screened ❑ Yes ❑ No Pumping Frequency ❑Weekly ❑Semi- month ❑Monthly ❑Quarterly ❑Semi -Annually ❑Other Serviced by Employee ❑ Yes ❑ No If Yes, how is grease disposed? ❑Brown Grease Barrel ❑Yellow Grease Barrel ❑Trash ❑Other Fluid Depth XII. Closing Requests Request a copy of the facility menu, inspection logs, training logs, and manifests. Request a copy of the water bill if available, ideally from the months of January or February, to determine water usage. Interviewee Information Primary Language ❑English ❑Spanish ❑Chinese ❑Japanese ❑Vietnamese ❑Other Perceived Language Comprehension ❑Fluent ❑Partial ❑Unsure How successful was the communication with the Interviewee? (1-10) 19 F-281 Page 4 of 4