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City of Santa Ana <br />FSE Interceptor/Trap Inspection Report <br />Permit No: ____________ Inspection Date: __________ <br />Name of Facility: ________________________________ Inspection Type:__________ <br />Address: ______________________________________ Inspector: _______________ <br />______________________________________________ Photo #: ________________ <br />Required Pumping Frequency: Citation Type: ____________ <br />Name and Title of Facility Contact: _________________________________________________ <br />Interceptor/Trap Location: ________________________________________________________ <br />Interceptor Liquid Depth: ______inches <br />FACILITY INSPECTION: Grease Removal Equipment (GRE) <br />1. Floating Fats, Oils, and Grease (FOG) Layer -(FF) Thickness: _____inches <br />2. Settable Solids (SS) Thickness: ______inches <br />3. Total FF and SS Thickness: ______inches % Accumulated FOG and SS: _____% <br />4. Last cleaning/pump-out date: __________ <br />5. Mechanical Condition: See Results for Deficiencies <br />6. GRE Pumping Record Keeping: See Results for Deficiencies <br />Comments: ________________________________________________________________________________ <br />__________________________________________________________________________________________ <br />__________________________________________________________________________________________ <br />INSPECTION RESULTS <br />Facility is in COMPLIANCE. No corrective action is required at this time <br />NOTICE OF NONCOMPLIANCE <br /> Y NFacility is in noncompliance Required corrective action includes <br /> of the items checked below: any or all of the following: <br />Interceptor/Trap is inaccessible for inspectionPromptly remove obstructions that <br />do not allow access to interceptor/trap <br />Interceptor/Trap FOG and settable solids Pump out Interceptor/Trap completely <br />capacity exceeded <br />Excessive FOG in the sample boxPump out sample boxcompletely when GRE is serviced <br />Discharge (Effluent Line) restrictedCleaneffluent line(Hydro-jet) <br />Baffle tubes plugged, submerged,Repair or replace baffletubes <br /> damaged or missing <br />Insufficient GRE record keepingMaintain GRE records(log and/or hauling/pumping records) <br />Pumping Frequency not within required intervalPump interceptor/trap within required frequency interval <br />Other ______________________________________Other __________________________________________ <br />______________________________________ __________________________________________ <br />The above checked item(s) must be corrected within _____________ days of receipt of this Notice of Noncompliance. <br />AKNOWLEDGEMENT OF RECIEPT OF INTERCEPTOR INSPECTION REPORT <br />______________________________________ ________________ <br />Signature of Facility Contact Date <br />______________________________________________________ <br />Signature of Inspector Date <br />____________________________________________________________________________________________________ <br />FOR OFFICE USE ONLY <br />City Council441 <br />Revised 12/28/2006 <br /> <br />