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GREASE TRAP CERTIFICATION (Form B)

The City of Kingsport Wastewater Department is requiring that this grease trap certification form by completed annually to verify all components of the grease trap are present and in good working condition. Have a Kingsport certified grease waste hauler or plumber complete this form and submit to the city. This certification form must be completed by a “Kingsport certified” grease waste hauler or plumber.

Address(Required)
Grease trap completely emptied and cleaned before inspection?(Required)
There is access to all trap chambers for cleaning?(Required)
Flow restrictor device is installed (before grease trap or at grease trap inlet)?(Required)
Flow restrictor device installation is correct (proper flow direction and orientation)?(Required)
Grease trap is vented (vent on flow restrictor)?(Required)
Grease trap has NO visible holes or leaks?(Required)
Baffle(s) (inlet, middle and outlet depending on design) are secure and operational?(Required)
Automatic or machine dishwasher is NOT connected to the grease trap?(Required)
No sewer clean-out covers missing or damaged?(Required)

IMPORTANT REQUIRED INFORMATION & RESPONSE:

If the answer to any of the above questions is “FAIL,” the equipment has failed certification. A statement of the plan of action to be taken, with date to be completed, needs to be provided in the “Response Comments” section at the bottom of this form.
This grease trap has ________ certification.(Required)
I have examined the interceptor and provided the above information.
Clear Signature
Name
MM slash DD slash YYYY
I certify to the best of my knowledge the above statements to be true and correct.
Clear Signature
Name
MM slash DD slash YYYY
Description
Required if “Fail” checked, identify problem, corrective action and provide planned date of corrective action)

Link to: City of Kingsport
City of Kingsport, Tennessee