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CITY OF SANTA ANA <br />Planning and Building Agency <br />Current FSE Equipment <br />Approved <br />FOR PERMIT ISSUANCE <br />FSE acknowledges that below is the existing cooking equipment of the facility and that no ct <br />anges will or.rur. <br />Master ID: <br />Equipment <br /># <br />Equipment <br /># <br />Equipment <br /># <br />Equi <br />r®er*: <br />4 <br />Automatic <br />Dishwasher <br />1 <br />Grill <br />0 <br />Rethermalizer <br />0 <br />3 Compartment <br />Sink <br />Broiler <br />0 <br />Hood <br />0 <br />Rotisserie <br />0 <br />Tilt Skillet <br />0 <br />Char Broiler <br />0 <br />Kettle <br />0 <br />Skillet <br />0 <br />Wok <br />0 <br />Deep Fryer <br />0 <br />Oven <br />0 <br />Smoker <br />0 <br />Stove <br />0 <br />Griddle <br />0 <br />Pressure Cooker <br />0 <br />Steamer <br />0 <br />Notice and Conditional Waiver Amendment Notice <br />The Developer/Owner acknowledges that no tenant improvements that include change of kitchen equipment, <br />expansion of dining area, and or change in type of operations or use, are being performed at this time. The <br />developer/owner has been notified that any improvements, that include what is mentioned above, will result in <br />the revocation of this waiver to install a grease interceptor. The City may amend this Notice and/or Conditional <br />Waiver at any time. Compliance with the requirements contained in this Notice and Conditional Waiver does <br />not relieve the FSE of its obligation to comply with the Fats, Oils, and Grease Control Regulations, any <br />applicable pretreatment regulations, standards or requirements under local, State, and Federal laws, including <br />any such regulations, standards, requirements or laws that may become effective during the term of this <br />Conditional Waiver. Non-compliance with any term or condition of this Notice and Conditional Waiver <br />constitutes a violation of the Fats, Oils and Grease Control Regulation and may result in revocation of the <br />Conditional Waiver. <br />Print Name (FSE Owner/Representative) I Sign Name (FSE Owner/Representative) I Date <br />BY signing, FSE owner agrees to all terms and conditions of this Notice and Conditional Waiver. <br />ma o Fernandez <br />Acti g Deputy Public Works Director <br />Water Resources Manager <br />Page 2 of 2 <br />