FOG

Appendix A: Grease Interceptor Sizing and Selection Worksheet

Applicant Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Business Name

Name of Food Service Establishment

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

REQUIRED DOCUMENTATION

Include the following documentation with this worksheet: kitchen plans, equipment schedule, menu, completed calculations for flow rate and grease capacity, HGI specifications sheet, and certified test report for grease capacity validation.

1.

2. Are there indirectly connected fixtures routed to the interior HGI? (An indirect connection means a pipe that does not connect directly with the drainage system but conveys liquid wastes by discharging into a plumbing fixture, interceptor, or receptacle which is directly connected to the drainage system such as floor drain for floor sink.)

Note: for interior installations, if the answer to question 2 is YES, use a one-minute drainage period, otherwise use a two-minute drainage period. For exterior installations, use a two- minute drainage period.

Step 1: Calculate Flow Rate

(1) Total Fixture Volume: blanks Flow Rate GPM (one or two-minute):blank OR

(2) Pipe Diameter (Table 2): blanks Flow Rate GPM (one or two-minute): blank

Step 2: Calculate Grease Capacity

(1) Grease Factor (Table 3) blanks* (2) Average meals per day=blank*

Grease Storage Capacity Calculation

Grease Produced (lbs)

**Prior written approval by the Utility is required for a pump-out schedule of less than 90 days.

Multiply grease factor (1) by average meals per day (2) = Daily Loading. Next, multiply the daily loading by the number of each 30, 60, and 90 days.

(3) Make and model of the grease interceptor selected:

(4) Is the material of construction compatible with a pH of 3?

(5) If the answer to number 4 is "NO", what material is the tank lined or coated with: *must provide evidence that the liner or coating is compatible with a pH of 3 and that it cannot be penetrated, scraped off or removed. Acid Resistant Enamel (ARE) coatings are not allowed.

(6) Flow Rate (GPM)blanks* Validated grease capacity*(lbs) blank*

* Grease capacity must be validated by a certified test report complete with incremental test data.

Please submit the completed Grease Control Device Sizing and Selection Worksheet to the Utility for approval along with all required documentation. Once approved, no substitutions shall be allowed without prior written approval from the Utility.

Signature

Date

La Grange Utilities