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CITY OF SANTA ANA <br />FOOD SERVICE ESTABLISHMENT <br />WASTEWATER DISCHARGE NOTICE <br />AND CONDITIONAL WAIVER <br />Effective Datei November 14, 20'16 <br />FSE Owner <br />FSE Name <br />FSE Address <br />FSE City, State, Zip <br />CALIFORNIA FOOD I\,4AMAGEMENT, LLC <br />BURGER KING RESTAURANT <br />2850 SOUTH BRISTOL STREET <br />SANTA ANA, CA 92704 <br />(lf Box ls Marked) Refer to Specific Conditional Waiver Requirement(s) <br />Effective December 15,2004, the City of Santa Ana adopted Ordinance Number NS 26-70 amending Chapter <br />39 of the Santa Ana l/unicipal Code adding fats, oils and grease (FOG) conkol regulations applicable to Food <br />Service Establishments (FSES). The ordinance requires all new and remodeled FSES to install and maintain <br />grease interceptors. FSEs without grease interceptors and that meet certain criteria are hereby issued a <br />conditional waiver under the terms of this Notice and Conditional Waiver. <br />FSEs will be routinely inspected to evaluate the effectiveness of their grease control measures. Existing FSES <br />that discharge FOG and are out of compliance with the Ordinance provisions will be required to install grease <br />interceptors. All FSES must implement Kitchen Best Management Practices (BMPs) to remove FOG from the <br />waste stream entering the sewer system. <br />Program Rules and Regulations <br />The City has established Rules and Regulations for the FOG Program. Refer to the City website at <br />httn:ii wr'vll .$anta-ana.orr:/p'"va/foq/cloqlrqqnts/fog rules and regulations.pdf or contact the FOG <br />Conkol Program Manager al (714], 647 -3320 for copies of the Rules and Regulations. Also refer to these <br />sources for the Fats, Oils, and Grease Control Regulations (Section 39-56 of the City's Municipal Code) and <br />for copies of forms and educational material. <br />Conditional Waiver <br />A Conditional Waiver to the requirement to install a grease interceptor is hereby granted. This waiver may be <br />revoked at any time upon a determination of one or more of the following: <br />Quantity of fats, oils and grease (FOG) discharge as measured or as indicated by the size of the food <br />service establishment (FSE) based on seating capacity, number of meals served, menu, water usage, <br />amount of on-site consumption of prepared food and other conditions have changed since the <br />granting of said waiver such that the FSE is contributing to FOG discharges. <br />ldentification of the FSE as a significant contributor of FOG into the Sewer System, which is based on <br />inspection or sampling of the FOG discharged from the FSE'S sewer lateral to the Sewer System. <br />Adequacy of implementation and compliance with Kitchen Best Management Practices (BlvlPs). <br />Change in sewer size, grade, and condition based on visual information. <br />Changes in operations that significantly affect FOG discharge. <br />Failure to comply with any of the specific requirements set forth below in this Conditional Waiver. <br />Any other condition deemed reasonably related to the generation of FOG discharges by the FOG <br />Control Program Manager. <br />Page I of 2 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />X <br />X <br />FSE ID: <br />FSE Owneri Rep Email:FSE Owner/Rep Phoner 8 j8-631-757i <br />A gravity grease interceptor is NOT required at this FSE: <br />1