GREASE TRAP CERTIFICATION (Form B)

Every food service establishment in the Metro Nashville Department of Water & Sewerage Services’area must have their grease trap (underthe-sink units) certified annually, as required by their FOG Permit, to verify that all components of the grease control equipment are present and

in good working condition.

Facility Name:_____________________________________________________Phone #:______________

Address:_______________________________________City:________________,TN. Zip Code________

PASS FAIL*

1. Grease trap completely emptied and cleaned before inspection? □ □

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2. There is access to all trap chambers for cleaning? □ □

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3. Flow restrictor device is installed (before grease trap or at grease trap inlet)? □ □

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4. Flow restrictor device installation is correct (proper flow direction and orientation)? □ □

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5. Grease trap is vented (vent on flow restrictor)? □ □

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6. Grease trap has NO visible holes or leaks? □ □

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7. Baffle(s) (inlet, middle and outlet... depending on design) are secure and operational? □ □

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8. Automatic or machine dishwasher is NOT connected to the grease trap? □ □

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9. No Sewer clean-out covers missing or damaged? □ □ ____________________________________________________________________________________________________________________________________

* 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 on attached sheet under “Response

Comments” (attach additional sheets to explain corrective action if necessary):

Inspector Certification - This grease trap has □ PASSED □ FAILED certification.

I _____________________________________________of __________________________________ (print name of inspector) (print company name)

certify that the above listed facility has a ____________ gallons per minute / ____________ pound capacity

grease trap. I have examined the grease trap and provided the above information.

________________________________ ________________ ____________________ (signature) (date) (phone number)

Facility Owner/Manager Certification

I _____________________________________________ certify to the best of my knowledge the above

(print name)

statements to be true and correct. ___________________________________ _______________ (signature) (date)

SUBMIT ORIGINAL CERTIFICATION FORM TO:

Metro Water Services, FOG Control Program, 1360 County Hospital Road, Nashville, TN 37218

This certification form must be completed by a “Metro Certified” Plumber or Grease Waste Hauler.

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Under the Sink Grease Trap Diagram

VENT PIPE

FLOW RESTRICTOR (Key component)

RESPONSE COMMENTS (required if “Fail” checked, identify problem, corrective action and

provide planned date of corrective action)