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Food Service Establishment (FSE) Grease Control Device (GCD) Registration Form

  1. GCD

  2. Remember to complete a separate form for each GCD in your establishment.

  3. Enter the Food Service Establishment (FSE) Information

  4. Best Management Practices (BMP) Trained*

  5. FSE Location*

  6. Food *

    Mark all that apply

  7. Enter the Yellow Grease Container Information

  8. Yellow Grease Container on-site? *

  9. Enter the GCD Information

  10. Grease Control Device (GCD) in FSE?*

  11. Select all that Apply

  12. Check One

  13. Certification

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

  14. Type name

  15. Address: 6040 Waterworks Rd., Norfolk, VA 23502

    O: 757-441-5678 ext. 229 M: 757-620-2688 Fax: 757-441-5639 Email:

  16. Water and Sewer Main Break 24-HR Emergency 757-823-1000

  17. Leave This Blank:

  18. This field is not part of the form submission.