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4. Fats, Oils, & Grease: Grease Control Device Registration

   GCD Registration is required for all food service establishments in the City of Norfolk.

6. Food Service Establishment Information
8. Select All That Apply:*

   1. Existing Establishment
   2. Change of Ownership
   3. New Business
   4. Relocating Business
   5. Renovation/Addition
   6. New Build-out

   1. Shell Build-out (tenant unknown)
   2. Building Permit
   3. Plumbing Permit
   4. Commissary
   5. Mobile Vendor/Food Truck
   6. Ghost Kitchen

   1. Pop-Up Kitchen
   2. Temporary Event Operator
   3. Farmers Market
   4. Food Manufacturer
   5. Other:
10. Other:
12. FSE Name:*
13. Physical Street Address:*
14. Zip Code:*
16. Corporate Name:*

    ie.  Norfolk, LLC. or Norfolk Corp.

17. Phone:*
18. Email:
20. Menu Type:*
    -- Select One --BakeryBar and GrillBarbeque Breakfast Bar/HotelBuffetBurger and Fries, Fast FoodCafeteriaCatererChineseCoffee ShopConvenience StoreDeep Fried Chicken/Seafood DeliFamily Restaurant Frozen YogurtGreekGrocery BakeryGrocery DeliGrocery Meat DepartmentIce CreamIndianItalianMexican, Fast FoodMexican, Full FarePizzaReligious InstitutionSandwich ShopSnack BarSteak and SeafoodSushiOther
21. Other:
23. Upload Menu 1:
24. Upload Menu 2:
25. Upload Menu 3:
27. Estimated number of meals sold per day:*
28. Do you have a fryer? *
    -- Select One --YesNo
29. Do you wash forks, knives & spoons?*
    -- Select One --YesNo
30. Do customers use plastic utensils?
    -- Select One --YesNo
32. Are there 2 or more food service businesses using the commercial kitchen space/waste services?

    1. Yes
    2. No

    Please refer all food service businesses using space/waste services to this registration form with the City of Norfolk FOG Program.

33. If YES. Then, upload List of Food Service Businesses using commercial kitchen/waste services:

    Only upload list of food businesses if you are the owner or operator of a commissary kitchen leasing the use of a commercial food space or providing food waste or grey water disposal to food service businesses, that do not have a brick & mortar establishment.

37. Person in Charge:
38. Phone:
40. Contact Title/Role:
41. Additional Contact:
43. Owner/Co. Name:
44. Owner/Co. Phone:
46. Owner's Address 1:
47. Address 2:
49. City:
50. State:
51. Zip:
55. The Hampton Roads Fats, Oils & Grease Best Management Practices Certification is required for all food service establishments (this includes mobile food trucks or food services leasing commercial kitchen space or waste disposal services):
57. HR FOG Best Management Practices (BMP) Certified?*

    1. Yes
    2. No

    If No, please visit the following link to complete the Online Free FOG Training: www.hrfog.com

58. HR FOG Certified Employee:
59. Upload HR FOG BMP Certification Card:*
63. Are you using a commercial kitchen as a commissary?

    Upload documents that apply and then go to the end of the form to sign and submit.  Thank you.

65. Commissary Agreement/Letter:

    Mobile vendors, food trucks, temporary event operators, food manufacturers or any food service businesses using a commercial kitchen for food processing and food waste disposal services in the City of Norfolk, must provide a copy of the commissary agreement.

66. City of Norfolk FOG Approval Letter:

    If using an already approved location as commissary, upload FOG Approval Letter.

68. FSE Used Cooking Oil (Yellow Grease) Recycling Information
70. Will cooking oil be used?

    1. Yes
    2. No
71. Location of Used Cooking Oil (Yellow Grease) Storage Container/Tank
    -- Select One --Interior ExteriorOther
72. Other:
74. Is the Used Cooking Oil (Yellow Grease) Container shared with other FSEs?
    -- Select One --YesNo
75. Upload image of storage tank/container:
77. Indirect Grease Hauler (Used Cooking Oil Removal Company):

    Please visit the link to see the list of haulers: IndirectGreaseHaulers.pdf (hrsd.com) 

78. Indirect Grease Hauler Phone Number:
80. Hood Cleaning Company:
81. Hood Cleaning Phone Number:
83. FSE Grease Control Device (GCD) Information

    Grease Control Device (GCD) or previously known as a grease trap, shall mean a device used to collect, contain, or remove food waste and grease from the wastewater while allowing the remaining wastewater to be discharged to the City/County/Town’s sanitary sewer system by gravity. Devices include: hydromechanical grease interceptors (HGI), automatic grease removal devices (AGRD), or gravity grease interceptors (GGI).

85. Does the FSE have a grease control device?

    1. Yes
    2. No
    3. I do not know.
86. Total # of GCDs:
90. Type of GCD:
    -- Select One --MetalPlasticConcreteFiberglass
91. Select all that Apply

    1. Exterior
    2. Interior
    3. Other
92. Describe Location of GCD?
94. Determining the Size of the Existing GCD:

    GCDs are sized based on Flow (GPM) and Capacity (Lbs.) or by Volume (gallons).  Most GCDs have a specification (spec) plate that will provide the information required.  If the GCD is missing the spec plate, the GCD can be measured: length x width x height

96. Gallons Per Minute (GPM)
97. Grease Capacity (Lbs.)
98. Gallons (gal.)
100. Manufacturer
101. Model
103. Upload Before Cleaning Photo:
104. Upload After Cleaning Photo:
105. Photo of GCD Cleaning Company Invoice/Manifest:

     Required if cleaned by a commercial company.

107. Is the FSE self cleaning? *

     1. Yes
     2. No

     *GCDs greater than 25gpm/50lbs are required to be cleaned by a certified commercial hauler.

108. Appendix C:

     (Alternate Maintenance Approval Request)

109. Describe self cleaning procedure and waste disposal:*
111. Cleaning frequency (select all that apply):

     1. Monday
     2. Tuesday
     3. Wednesday
     4. Thursday
     5. Friday
     6. Saturday

     1. Sunday
     2. 7 Days
     3. 30 Days
     4. 60 Days
     5. 90 Days
     6. Other:

     At no time shall a GCD be cleaned less frequently than once every three (3) months.

112. Other
116. Do you have another GCD?

     1. Yes
     2. No
118. Where is the GCD located?
119. Select all that apply:

     1. Interior
     2. Exterior
     3. Other
120. Please provide description:
122. Check One:

     1. Gallons Per Minute (GPM)/Pounds
     2. Gallons
123. Type of GCD:
     -- Select One --Metal PlasticConcreteFiberglass
125. Provide details:

     Please provide gallons per minute and grease capacity or total gallons.

127. Manufacturer:
128. Model:
130. GCD Cleaning Service Company/Person:
131. Phone:
133. Is the FSE self cleaning?*

     1. Yes
     2. No

     *GCDs greater than 25gpm/50lbs are required to be cleaned by a certified commercial hauler.

134. Upload Before and After Cleaning Photos:*
136. Describe self cleaning procedure and waste disposal:*
138. Cleaning frequency (select all that apply):

     1. Monday
     2. Tuesday
     3. Wednesday
     4. Thursday
     5. Friday
     6. Saturday
     7. Sunday
     8. 7 Days
     9. 30 Days
     10. 60 Days
     11. 90 Days
139. Other
140. Upload GCD equipment photo:
144. Do you have another GCD?*

     1. Yes
     2. No
146. Where is the GCD located?
147. Select all that apply:

     1. Interior
     2. Exterior
     3. Other
148. Please provide description:
150. Check One:

     1. Gallons Per Minute (GPM)/Pounds
     2. Gallons
151. Type of GCD:
     -- Select One --Metal PlasticConcreteFiberglass
153. Provide details:

     Please provide gallons per minute and grease capacity or total gallons.

155. Manufacturer:
156. Model:
158. GCD Cleaning Service Company/Person:
159. Phone:
161. Is the FSE self cleaning?*

     1. Yes
     2. No

     *GCDs greater than 25gpm/50lbs are required to be cleaned by a certified commercial hauler.

162. Upload Before and After cleaning photos:*
164. Describe self cleaning procedure and waste disposal: *
166. Cleaning frequency (select all that apply):

     1. Monday
     2. Tuesday
     3. Wednesday
     4. Thursday
     5. Friday
     6. Saturday
     7. Sunday
     8. 7 Days
     9. 30 Days
     10. 60 Days
     11. 90 Days
167. Other:
168. Upload GCD equipment photo:
170. GCD Hauler/Pumper:

     Please inform cleaning company that at each cleaning/pump out, manifests can be directly emailed to the City of Norfolk FOG Office:

171. Contact Information:

     fog@norfolk.gov

175. Upload Plans and Equipment Schedule
176. Upload Plumbing Plans if available:
178. FOG Approval Request Paperwork
     New GCD FOG Request

     *ONLY REQUIRED FOR NEW INSTALLATIONS OF GCDS OR RETROFITTING.

179. Appendices:

     (As Requested)

181. Certification

     I hereby certify that I am the owner/authorized representative to make entries and that the information on this sheet is correct. Any falsification, misrepresentation, or misleading information VOIDS this registration form.

183. Signature *
     Type name
184. Date*
     Date
188. Thank you for keeping Norfolk sewers grease free!
     Visit our FOG page for more information.

     Norfolk Department of Utilities - Division of Water Quality
190. 6040 Waterworks Rd., Norfolk, VA 23502
     Call or Text: 757-620-2688 Fax: 757-441-5639 Email: fog@norfolk.gov
192. Water and Sewer Main Break 24-HR Emergency (757) 823-1000
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195. 1. Receive an email copy of this form.
196. Email address

     This field is not part of the form submission.

197. Submit Submit and Print

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