KUB

Prior to beginning the application, the owner or their authorized representative must read the following:
KUB's Grease Control Program

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Please reference tracking number UNKNOWN for related correspondence.

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* Required Field

Mobile Food Unit Information

Mobile Food Unit Business Name *

Owner's Name:

Salutation * Mr. Ms.

First Name *

Last Name *

Owner's Physical Address (cannot be a P.O. Box):

Address 1 *

Address 2

City *

State *

Zip Code *

KUB Account Number at Owner's Physical Address (if any KUB utilities are provided there)

Owner's Mailing Address Same as Above? * Yes No

Owner's Mailing Address

Address 1 *

Address 2

City *

State *

Zip Code *

Owner's Phone *

Owner's Cell Phone

Alternate Phone 1

Website Address

Email *

Re-type Email *

Is this mobile food unit designated as a corporation? * Yes No

Corporation Information:

Corporation Name *

Corporation Contact Name *

Corporation Mailing Address:

Address 1 *

Address 2

City *

State *

Zip Code *

Corporation Phone *

Corporation Registered Agent *

To which address should program information and official correspondence be mailed? * Owner's Physical Address Owner's Mailing Address Corporate Mailing Address

Briefly describe this unit's menu *

Attach this unit's menu.

Estimated number of days per month this unit will be open for business? *

What will be served from this Unit? (Mark all that apply) * Drinks Only Snacks Breakfast Lunch Dinner

How many of each of the following types of equipment are or will be installed in this mobile food unit (not including the restrooms)?

Enter a zero if none:

Food Waste Garbage Grinders or Disposals *

Janitor / Mop Sinks *

Floor Drains (Any Size, Not Floor Sinks) *

Dishwasher Pre-Rinse Sinks *

Dishwashers (any size) *

Single Sinks (Hand-washing only) *

Single Sinks (Food prep and non hand-washing) *

Double Sinks *

Triple Sinks *

Woks *

Grills *

Open BBQ Grills *

Ovens (conventional or convection) *

Ovens (microwave) *

Fryers *

Will a dishwasher be used within this unit? * Yes No

Provide the following information for each dishwasher

Dishwasher: Gallons of water discharged per cycle

Dishwasher: Average racks/cycles per day that are or will be put through the dishwasher

Will this unit only serve pre-packaged food that is prepared and cooked outside of the unit? * Yes No

Will this unit only serve food on disposable packaging with disposable utensils? * Yes No

What is the size of this unit's wastewater holding tank in gallons (not the grease trap)? *

Describe how the wastewater holding tank waste will be disposed of (not the grease trap waste). *

Provide the address where the wastewater holding tank will be disposed of, not the grease trap waste (Street, City, and Zip)

Address 1 *

Address 2

City *

State *

Zip Code *

Does this unit have an existing grease trap? * Yes No

Provide the following:

Trap Capacity Size (enter a number)

Trap Capacity Units gal. lbs.

Describe how the grease trap waste will be disposed of (not the holding tank waste) if the unit is required to have one. *

Provide the address where the grease trap waste will be disposed of (not the holding tank waste) if the unit is required to have one. (street, city, zip)

Address 1 *

Address 2

City *

State *

Zip Code *

Any Additional Grease Control Equipment Comments

IMPORTANT IF YOU PLAN TO DISCHARGE YOUR HOLDING TANK OR GREASE TRAP WASTE INTO AN EXISTING FOOD SERVICE FACILITY'S GREASE INTERCEPTOR, THAT INTERCEPTOR MUST BE 500 GALLONS OR LARGER AND A LETTER OF PERMISSION SIGNED BY THE FOOD SERVICE FACILITY'S OWNER MUST BE SUBMITTED TO KUB PRIOR TO A KUB PERMIT BEING ISSUED.

Application Submittal

Type your name as an Electronic Signature *

Title/Relationship to Mobile Food Unit *

By checking this box and submitting this application form, I certify that I am, or have been authorized by the business and/or mobile vending unit's owner, to sign this document and acknowledge that I have read KUB's Grease Control Program. I also understand that if the unit's operations change or there is a change in ownership of the business, I must immediately submit to KUB in writing such changes or possibly be in violation of my Grease Control Permit, which is nontransferable. I am aware that there are penalties for submitting false information, including the possibility of enforcement actions in accordance with KUB's Rules and Regulations for the Wastewater Division, KUB's Grease Control Program and its associated Enforcement Response Guide.

My electronic signature above indicates that I am the person responsible for ensuring that the business listed on this Grease Control Permit Application is compliant with KUB's Rules and Regulations for the Wastewater Division and KUB's Grease Control Program. I agree that the business listed on this Grease Control Permit Application will abide by all applicable provisions of KUB's Rules and Regulations for the Wastewater Division and understand that failure to do so may cause disconnection of water service or other enforcement actions in accordance with the Grease Control Program Enforcement Response Guide. I also understand that I am responsible for the grease control equipment and meeting the requirements of the Grease Control Program, even if I do not own the property.

NOTICE: Failure of the responsible party for the mobile food unit business listed on this Grease Control Permit Application to sign this application does not relieve the mobile food unit business from any compliance requirements of KUB's Rules and Regulations for the Wastewater Division or KUB's Grease Control Program.

I agree

Additional Comments

Account Heading

Grease Control Program: Mobile Food Unit

Mobile Food Unit Information

Owner's Name:

Owner's Physical Address (cannot be a P.O. Box):

Owner's Mailing Address

Corporation Information:

Corporation Mailing Address:

How many of each of the following types of equipment are or will be installed in this mobile food unit (not including the restrooms)?

Provide the following information for each dishwasher

Provide the address where the wastewater holding tank will be disposed of, not the grease trap waste (Street, City, and Zip)

Provide the following:

Provide the address where the grease trap waste will be disposed of (not the holding tank waste) if the unit is required to have one. (street, city, zip)

Application Submittal