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Food Service Facility Quarterly Report

  1. Directions
    Include cleaning and maintenance receipts along with the Maintenance Log when submitting. The quarterly reports shall be postmarked, faxed, e-mailed or hand delivered no later than ten (10) business days following the reporting quarter. If you have questions, please call 317-595-3281 or email us at
  2. Designated facility owner, registered agent or responsible official
  3. Grease waste hauler (company that hauls interceptor/trap waste)
  4. Grease waste hauler (company that hauls "yellow" grease stored in a container)
  5. Has a modification been granted to your facility?*
  6. Leave This Blank:

  7. This field is not part of the form submission.