Liquid Trade Waste Inspection Report / Food Premises

• Liquid Trade Waste Reference Number

• Site / Client

• Location
  Address

• Lot Section DP

• Parcel number

• Assessment number

• Conducted on

  Date

Contact Details

• Contact Person

• Contact phone number/s

• Contact email address

• Owners name

• Owners mailing address

Premises & Inspection Details

• Business Type

  Select Cafe Takeaway Restaurant Coffee Shop Pizza Shop Delicatessen Hotel Restaurant Club Restaurant Motel & Restaurant Supermarket Butchery Aged Care Facility Fish Processing Sandwich / Salad Bar Ice Creamery Community Hall Commercial Kitchen Hospital Fast Food Outlet Motel / Minimal Hot Food

  • Cafe
  • Takeaway
  • Restaurant
  • Coffee Shop
  • Pizza Shop
  • Delicatessen
  • Hotel Restaurant
  • Club Restaurant
  • Motel & Restaurant
  • Supermarket
  • Butchery
  • Aged Care Facility
  • Fish Processing
  • Sandwich / Salad Bar
  • Ice Creamery
  • Community Hall
  • Commercial Kitchen
  • Hospital
  • Fast Food Outlet
  • Motel / Minimal Hot Food

• Classification

  A

  B

  C

  S

• Category

  1A

  2A

• Water Meter #

• Meter size

  Select 20mm 25 mm 32 mm 40 mm 50 mm 80 mm 100 mm

  • 20mm
  • 25 mm
  • 32 mm
  • 40 mm
  • 50 mm
  • 80 mm
  • 100 mm

• Liquid Trade Waste Discharge Factor

  Select 0 10 20 30 50 60 80 90

  • 0
  • 10
  • 20
  • 30
  • 50
  • 60
  • 80
  • 90

• Sewer Discharge Factor

  Select 10 50 70 75 80 85 90 95 100

  • 10
  • 50
  • 70
  • 75
  • 80
  • 85
  • 90
  • 95
  • 100

• Sewerage Treatment Plant catchment

  Select Bermagui Bega Candelo Cobargo Eden Kalaru Merimbula Tathra Wolumla Tura Beach

  • Bermagui
  • Bega
  • Candelo
  • Cobargo
  • Eden
  • Kalaru
  • Merimbula
  • Tathra
  • Wolumla
  • Tura Beach

• Sewerage Pump Station catchment

• Drawing of system (if required)

  Drawing

Reason for Inspection

• Reason

  Select New Discharger Initial Inspection Routine Annual Inspection Re-Inspection Investigation Sample taken

  • New Discharger
  • Initial Inspection
  • Routine Annual Inspection
  • Re-Inspection
  • Investigation
  • Sample taken

PRETREATMENT

Equipment Type

Grease Arrestor

• Required

  Yes

  No

  N/A

• In Place

  Yes

  No

  N/A

• Maintained

  Yes

  No

  N/A

• Condition OK

  Yes

  No

  N/A

• Compliant

  Yes

  No

  N/A

Floor Waste Baskets

• Required

  Yes

  No

  N/A

• In Place

  Yes

  No

  N/A

• Maintained

  Yes

  No

  N/A

• Condition OK

  Yes

  No

  N/A

• Compliant

  Yes

  No

  N/A

Sink Screens

• Required

  Yes

  No

  N/A

• In Place

  Yes

  No

  N/A

• Maintained

  Yes

  No

  N/A

• Condition OK

  Yes

  No

  N/A

• Compliant

  Yes

  No

  N/A

Other (please describe)

• Required

  Yes

  No

  N/A

• In Place

  Yes

  No

  N/A

• Maintained

  Yes

  No

  N/A

• Condition OK

  Yes

  No

  N/A

• Compliant

  Yes

  No

  N/A

• Additional notes

Containment Methods

• STORMWATER

• Isolated from sewer

  Yes

  No

  N/A

• Roofing

  Yes

  No

  N/A

• Bunding

  Yes

  No

  N/A

• CHEMICAL / OIL STORAGE
  

• Isolated from sewer

  Yes

  No

  N/A

• Roofing

  Yes

  No

  N/A

• Bunding

  Yes

  No

  N/A

• Additional notes

Housekeeping/other

• Odours present

  Yes

  No

  N/A

• Housekeeping practices within approval

  Yes

  No

  N/A

• Site accessible

  Yes

  No

  N/A

• Waste disposal by NSW EPA approved contractor

  Yes

  No

  N/A

• Pits & screens clean

  Yes

  No

  N/A

• Activities within classification /approval

  Yes

  No

  N/A

• Current Material Safety Data Sheets (MSDSs) available

  Yes

  No

  N/A

• Correct Back flow prevention device in place

  Yes

  No

  N/A

• Back flow Prevention Device certification to Council current

  Yes

  No

  N/A

• Additional notes

FOLLOW UP REQUIREMENTS

• Select Immediate 1 week 2 weeks 1 month 6 months 12 months

  • Immediate
  • 1 week
  • 2 weeks
  • 1 month
  • 6 months
  • 12 months

• Select Immediate 1 week 2 weeks 1 month 6 months 12 months

  • Immediate
  • 1 week
  • 2 weeks
  • 1 month
  • 6 months
  • 12 months

• Select Immediate 1 week 2 weeks 1 month 6 months 12 months

  • Immediate
  • 1 week
  • 2 weeks
  • 1 month
  • 6 months
  • 12 months

General Comments

Information to be provided to Council

• Select Liquid Trade Waste Application Back flow Prevention Device Certification

  • Liquid Trade Waste Application
  • Back flow Prevention Device Certification

Further Action

• Further action required

  Select Nil Reinspection Warning letter Improvement Notice Prohibition Order Penalty Notice Other Pending

  • Nil
  • Reinspection
  • Warning letter
  • Improvement Notice
  • Prohibition Order
  • Penalty Notice
  • Other
  • Pending

• Comments

Fees to be Charged

• Apply Inspection fee

  Yes

  No

  N/A

I have read this report and understand the contents.

• Owner / Employee signature

  Sign

• Officers Name

  Select Tony Jolley Anthony Dowd Ken McLeod

  • Tony Jolley
  • Anthony Dowd
  • Ken McLeod

• Officers signature

  Sign

• NB: Assessment report contains findings from date/time of inspection only