19F - RECEIVE AND FILE SEWER SYSTEM

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City of Santa Ana FSE Interceptor/Trap Inspection Report Permit No: Name of Facility: Address: Required Pumping Frequency: Name and Title of Facility Contact: Interceptor/Trap Location: Interceptor Liquid Depth: inches FACILITY INSPECTION: Grease Removal Equipment (GRE) 1. Floating Fats, Oils, and Grease (FOG) Layer -(FF) Thickness: inches 2. Settable Solids (SS) Thickness: inches 3. Total FF and SS Thickness: inches % Accumulated FOG and SS: 4. Last cleaning/pump-out date: 5. Mechanical Condition: See Results for Deficiencies 6. GRE Pumping Record Keeping: See Results for Deficiencies Comments: INSPECTION RESULTS ❑ Facility is in COMPLIANCE. No corrective action is required at this time ❑ NOTICE OF NONCOMPLIANCE Y N Facility is in noncompliance of the items checked below: ❑ ❑ Interceptor/Trap is inaccessible for inspection El ❑ Interceptor/Trap FOG and settable solids capacity exceeded ❑ ❑ Excessive FOG in the sample box El ❑ Discharge (Effluent Line) restricted - ❑ ❑ Baffle tubes plugged, submerged, damaged or missing ❑ ❑ Insufficient GRE record keeping aA ❑ ❑ Pumping Frequency not within required interval ❑ ❑ Other Inspection Date: Inspection Type: Inspector: Photo #: Citation Type: Required corrective action includes any or all of the following: ❑ Promptly remove obstructions that do not allow access to interceptor/trap ❑ Pump out Interceptor/Trap completely ❑ Pump out sample box completely when GRE is serviced ❑ Clean effluent line (Hydro -jet) ❑ Repair or replace baffle tubes ❑ Maintain GRE records (log and/or hauling/pumping records) ❑ Pump interceptor/trap within required frequency interval ❑ Other The above checked item(s) must be corrected within days of receipt of this Notice of Noncompliance. AKNOWLEDGEMENT OF RECIEPT OF INTERCEPTOR INSPECTION REPORT Signature of Facility Contact Signature of Inspector Date Date FOR OFFICE USE ONLY 19F-283 Revised 12128/2006