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IX. Kitchen Equipment <br />Tvpe <br />❑ Deep Fryers <br />❑ Char Broiler <br />❑ Char Broiler w/Grease Burner <br />❑ Griddles <br />❑ Grills <br />❑ Kettles <br />❑ Oven <br />❑ Rotisserie <br />❑ Stoves <br />❑ Woks <br />❑ Other <br />X. Fixtures <br />Quantity <br />❑1❑2❑3❑4 <br />❑1❑2❑3❑4 <br />❑1❑2❑3❑4 <br />❑1❑2❑3❑4 <br />❑1❑2❑3❑4 <br />❑1❑2❑3❑4 <br />❑1❑2❑3❑4 <br />❑1❑2❑3❑4 <br />❑1❑2❑3❑4 <br />❑1❑2❑3❑4 <br />❑1❑2❑3❑4 <br />Catch Pan for Grease <br />❑Yes ❑No ❑N/A <br />❑Yes ❑No ❑N/A <br />❑Yes ❑No ❑N/A <br />❑Yes ❑No ❑N/A <br />❑Yes ❑No ❑N/A <br />❑Yes ❑No ❑N/A <br />❑Yes ❑No ❑N/A <br />❑Yes ❑No ❑N/A <br />❑Yes ❑No ❑N/A <br />❑Yes ❑No ❑N/A <br />❑Yes ❑No ❑N/A <br />Type <br />Screen <br />Compartm <br />Pipe Diameter <br />Direct Plumbing/ <br />Connected <br />Floor Sink/Shared <br />To Grease <br />ents <br />— <br />Floor Sink <br />Tra <br />❑ Hand Sink <br />❑Yes ❑No <br />010203 <br />03/4" ❑1" ❑1'/V01%"❑2" <br />❑DP❑FS ❑SFS <br />❑Yes ❑No <br />❑ Hand Sink <br />❑Yes ❑No <br />010203 <br />03/4" 01" ❑1'/V01%"❑2" <br />❑DP❑FS ❑SFS <br />❑Yes ❑No <br />❑ Mop Sink_ <br />❑Yes ❑No <br />010203 <br />03/4" 01" ❑1'/V0 1%"❑2" <br />❑DP ❑FS ❑SFS <br />❑Yes ❑No <br />Floor Mounted <br />❑Yes ❑No <br />❑ Mop Sink_ <br />❑Yes ❑No <br />010203 <br />03/4" 01" ❑1'/V0 1%"02" <br />❑DP ❑FS ❑SFS <br />❑Yes ❑No <br />Floor Mounted <br />❑Yes ❑No <br />❑ Pot Sink_ <br />❑Yes ❑No <br />010203 <br />03/4" 01" ❑1'/V01%"❑2" <br />❑DP❑FS ❑SFS <br />❑Yes ❑No <br />Grinder <br />❑Yes ❑No <br />❑ Pot Sink_ <br />❑Yes ❑No <br />010203 <br />03/4" 01" ❑1'/V01%"❑2" <br />❑DP❑FS ❑SFS <br />❑Yes ❑No <br />Grinder <br />❑Yes ❑No <br />❑ Prep -Sink— <br />❑Yes ❑No <br />010203 <br />03/4" 01" ❑1'/V01%"❑2" <br />❑DP❑FS ❑SFS <br />❑Yes ❑No <br />❑ Prep -Sink_ <br />❑Yes ❑No <br />010203 <br />03/4" 01" ❑1'/V01%"❑2" <br />❑DP❑FS ❑SFS <br />❑Yes ❑No <br />❑ Pre -Rinse_ <br />❑Yes ❑No <br />010203 <br />03/4" 01" ❑1'/V01%"❑2" <br />❑DP❑FS ❑SFS <br />❑Yes ❑No <br />Sink <br />Grinder ❑Yes ❑No <br />❑ Other <br />❑Yes ❑No <br />010203 <br />03/4" 01" ❑1'/V01%"❑2" <br />❑DP❑FS ❑SFS <br />❑Yes ❑No <br />❑ Commercial <br />❑Yes ❑No <br />03/4" 01" ❑1'/V01%"❑2" <br />❑DP❑FS ❑SFS <br />❑Yes ❑No <br />Dishwasher <br />Hoods <br />Qtv. Cleaned By Cleaning Method <br />Maint Documented? ❑FSE ❑Wash <br />❑Yes ❑No ❑Contractor ❑Solvent <br />Date of Last Cleaning Contractor Name: ❑Other <br />Clean Freg <br />❑Monthly <br />❑Quarterly <br />❑Annually <br />❑Other <br />Water Disposal <br />❑Mop Sink <br />❑General Drain <br />❑Off Site Disposal <br />❑Other* <br />19F-280 <br />Page 3 of 4 <br />