Grease Interceptor Service Report

2. Business Name*

3. Contact at business

5. Address*

6. Address 2

8. City*

9. State*

10. Zip code*

12. Phone

13. Email

15. Grease Interceptor Service Company Name

17. Attach service receipt (.pdf or .jpg)*

    Receipt must be included. Please do not leave spaces in your filename (example-yes.pdf and ExampleYes.jpg).

21. Please provide your contact information, if different from above.

23. Your Name

24. Your Email

26. Your Phone

30. Grease interceptor measurement (optional)
    Please use inches for all measurements

    Please use inches for all measurements

32. 

34. Chamber 1 grease depth

35. Chamber 2 grease depth

37. Chamber 1 solid depth

38. Chamber 2 solid depth

40. Liquid depth of grease interceptor

41. Gallons removed

43. Grease interceptor condition

    1. Functional

    1. Needs repair

45. Additional Comments

47. Date pumping occurred
    Date pumping occurred

48. Frequency of pumping for this location

Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field