1. GENERAL INFORMATION
Name of Facility   

Contact Person     

Physical Address   

Mailing Address     
Note: Please include City, State, and Zip Code.

Phone Number       

Fax Number           

E-mail Address     

2. OWNERSHIP
Owner Name           

Contact Person       

Mailing Address    
Note: Please include City, State, and Zip Code.

Phone Number        

OUC Account #      
*Note: This is a required field.

OUC Customer Name:    
Please provide customer name exactly as it appears on your bill.
*Note: This is a required field.

Fax Number              

Owner E-mail Address

3. FACILITY TYPE
Facility Type   Automatic/Manual Car Wash Automotive Fueling Station Automotive Service Station Other

If Other, please specify 

4. HOURS OF OPERATION
Hours of Operation - Weekdays 

Hours of Operation - Weekends  

5. STRUCTURE TYPE
Type of Structure  Existing Facility New Facility (Construction) Remodeled Facility Freestanding Facility Attached Facility

6. EXPANSION PLANS
Is future expansion planned?  yes no

If yes, please describe..

.

7. APPROXIMATE NUMBER OF SERVICES PERFORMED
Approx. number of services performed per day

Busiest day of the week Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Average number of services rendered on this day

8. CLEAN-UP/POLLUTION PREVENTION PROCEDURES
Briefly explain clean-up procedures. (For example, How are spilled oils contained an/or cleared?)

Have pollution prevention measures been implemented?  
yes no 

If yes, briefly list the pollution prevention measures being used and describe the employee-training schedule. 

9. RECYCLING
Do you recycle spent oils & grease?    yes no 

If yes, briefly explain the program and the grease handling procedures, including information on equipment.

Do you reuse water and/or other cleaning agents?   yes no 

If not, do you have plans to intitate a recycling program?  
yes no 

10. GREASE MANAGEMENT DEVICES           SIZE / DRAIN SIZE
Sand Interceptor     yes no                  

Recycle holding tank    yes no           

Oil/Water seperator      yes no            

11. CONSTRUCTION DOCUMENTS *for new construction
Please provide the City a copy of the "As-Builts" plans, including the specifications, the facility layout (site plan), O&M procedures for the grease interceptor, installation instructions for grease handling equipment, and complete plumbing diagrams (schematics) showing the plumbing fixture(s) connected to the new waste piping system with the flow direction indicated.

12. CERTIFICATION STATEMENT
By typing your name in the box provided below, you are certifying that the information provided for the User Information Survey, to the best of your knowledge, is accurate and complete. You understand that the User Information Survey serves as the application for issuance of the Registration Certificate for the City of Orlando Oil & Grease Management Program. You further understand that falsification of this information is a violation of the City of Orlando Code, and as such, become subject to enforcement actions and penalties as set forth in the City Code.

Type name here
*Note: This is a required field.