TE 2 Renewal Grease Traps Monthly Pickup Summary Log.pdf
PDF 45 KB Posted
- Attached to
- Grease Trap Pumping, Cleaning and Servicing Federal contract opportunity
- Solicitation number
- W912CN-20-Q-0023
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| W912CN-20-Q-0023-0003 CONFORM.pdf | ||
| W912CN-20-Q-0023-0003.pdf | ||
| Solicitation W912CN-20-Q-0023.pdf | ||
| TE 1 Grease Trap Oahu Locations.xlsx | XLSX spreadsheet |
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Text version
Year
SIGNED: _________________________________________
0 total PRINT NAME: _____________________ 0 total
DATE: __________________________
OFFICE
USE ONLY
CITY AND COUNTY OF HONOLULU
DEPARTMENT OF ENVIRONMENTAL SERVICES
RGH MONTHLY PICKUP SUMMARY LOG
This log shall be submitted monthly either by e-mail, fax or postal mail and is due by the 15th of the following month Failure to submit this log will subject you to enforcement and possible fines.
E-MAIL to envlwh@honolulu.gov FAX to (808)768-1553
Postal mail to Department of Environmental Services 1000 Uluohia Street. Suite 303
Kapolei, HI 96707
Attention: Regulatory Control Branch
Company Name License Plate:
Month Name of Preparer:
DATE #
GREASE
Gallons
DISCHARGE
SITE
DATE #
OIL
Gallons
DISCHARGE
SITE
"I certify under penalty of law that this document and all attchments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete.
I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations."
** Please submit
Gallons in a number format without commas and decimals.
*Please submit Day of the Month in a number format (1 to 31). Do not submit the month and the year.
Date
Gallons**
Received Delivered Late Enforceme for example
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