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IV. Location <br />Information <br />Location Information Specialty Type Seating <br />(Check One) (Check One) (Check One) <br />Catering American-Burger Ice Cream Sit-down <br />Hospital Bagel Indian Take-out <br />Hotel Bakery Italian Combo <br />Mall/Food Court Barbecue Japanese/Sushi <br />Nightclub/Bar Cafeteria/Buffet Korean <br />Prison Chicken Meat/Carniceria <br />Chain Status(Check <br />School Chinese Mexican <br />One) <br />Stadium/Amusement Park Coffee Shop Pizza <br />Chain <br />Stand-alone Restaurant Cookie Seafood <br /> <br />Strip-Mall/Attached Deli/Sandwich Steakhouse <br />Independent <br />Supermarket Doughnut Vegetarian <br />Other_________________ French Vietnamese <br />Greek Other________ <br /> <br />V. FOG Sources VI. UPC <br /> <br />Oils Meats Inside Seating Capacity ______________ <br />(One or More) (One or More) Outside Seating Capacity_______________________ <br />Butter Beef During Peak Hours: # of Meals Served per Hour ______ <br />Lard Chicken # of Employees working _______ <br />Margarine Pork Non-Disposable Dish Usage Yes No <br />Peanut Oil Seafood Significant Use of Pots and Pans Yes No <br />Shortening <br />Vegetable Oil <br />VII. Lateral Line <br /> <br />Clean Out <br />Lateral Cleanout Location _____________________________________________ <br /> <br />Additives Used <br />Is an additive being used? Yes No Type: Biological Chemical Unknown <br />If Yes, List product name ______________________________________MSDS Yes No <br />Purpose (One or More): Odor Control Line Cleaning Grease Interceptor Other____________ <br /> <br />Laterals <br />Lateral Cleaning Frequency Twice a month Monthly Quarterly Semi-Annually <br />Annually Other________________ <br />Contractor Name ____________________________________________________ <br /> <br />VIII. Yellow Grease Disposal (Waste Hauling) <br /> <br />Recycler Name _____________________________________________ <br />Drum Bin 5 Gallon Container Other________________________________ <br />Approximate Gallons <55 56-150 >150 <br />Pick-up Frequency Twice a month Monthly Quarterly Semi-Annually <br /> <br />Yellow Grease Disposal Documentation <br />Date of Last Pick-up __________________________________________ <br /> <br /> <br /> <br /> <br />Page 2 of 4 <br />City Council43710/21/2025 <br /> <br />