2. Food Establishment Service (FSE) Name*
3. DBA Name
5. City of Durango Business License #*
6. City of Durango Utility Account #*
7. Facility Phone Number*
8. FSE Type*
   -- Select One --Fast FoodRestaurantIce Cream/Candy ShopCoffe ShopBar & GrillBarGrocery

   What Type of FSE are You Operating
10. Grease Intercector Model*
11. Grease Interceptor Manufacturer*
13. Flow Rate/Grease Capacity*
14. Solids Capacity*
15. Liquid Capacity*
17. Weight*
18. Where is it installed?*
    -- Select One --IndoorOutdoor
20. Please provide the link to where you purchased this model
22. Facility Address*
23. Zip
25. Mailing Address
26. Suite #
28. City
29. State
30. Zip
34. Grease Hauler Company*
    Provide the business name of the company that hauls your grease away
35. Colorado Certificate of Registration #
36. State of Colorado
    Waste Grease Management
38. Contact Name
39. Grease Waste Hauler Business Phone #*
41. Address1*
42. Suite #
44. City*
45. State*
46. Zip*
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48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

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