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Grease Control Device (GCD) Cleaning Log
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Enter Identifying FSE Information
FSE Name
*
Address
*
Apt./Unit
Zip
*
GCD Location
*
-- Select One --
Exterior
Floor
US
Other
Other
Enter GCD Cleaning Information
Max amount of grease + solids (25% capacity):
By law, records must be retained on-site for at least three years.
Date Cleaned
*
Date Cleaned
Cleaned By
*
Company or person
A. Grease
*
Amount removed in inches
B. Solids
*
Amount removed in inches
C. Total Depth (no air)
*
This is the total of ALL liquids and solids (water + grease + solids, amount removed in inches)
Calculation
Grease (A) plus (+) Solids (B) divided by (/)Total (C) multiply by (X) 100 = Percent (%) of FOG
Percent of FOG
*
A + B / C x 100 = % FOG
GCD Photo Before Cleaning
GCD Photo After Cleaning
GCD Photo Before Cleaning Photo2 (optional)
GCD Photo Before Cleaning Photo2 (optional)
Pump Out Invoice
For GCD units > 50 gpm/100 lbs.
Certification
I hereby certify that I am the owner/authorized representative to make entries to this maintenance log and that the information on this sheet it correct. Any falsification, misrepresentation or misleading information VOIDS this maintenance log.
Signature
*
Date
*
Date
Thank you for keeping Norfolk sewers grease free!
Visit our FOG page for more information.
Norfolk Department of Utilities - Division of Water Quality
Address: 6040 Waterworks Rd., Norfolk, VA 23502
O: 757-441-5678 ext. 229 M: 757-620-2688 Fax: 757-441-5639 Email: UTFOG@norfolk.gov
Water and Sewer Main Break 24-HR Emergency 757-823-1000
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