FOOD TRUCK / MOBILE VENDOR FATS, OIL AND GREASE DISCHARGE
PERMIT APPLICATION FORM

• Any missing or incomplete information may result in delays in processing this application. The City will not process incomplete Permit Applications.  

• Applicant shall be the owner of the proposed Food Service Establishment or the presiding officer of the legal entity owning the proposed Food Service Establishment.

• Documentation required by this application shall be submitted with this application.

• Any section that requires additional space or documentation shall be included as an attachment and labeled to identify the appropriate section.

• For assistance please contact the GMP Official at 803-329-8703 or email fog@cityofrockhill.com

SECTION A - General Information

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SECTION A - General Information

Business Name

Phone Numberext.

Website

Mailing Address

SECTION A - General Information(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Signatory Authority of Business

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Signatory Authority of Business

Name

Title

Email

Designated Contact of Business

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Designated Contact of Business

Name

Title

Email

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SECTION B - Physical Location of Operation

Please select the Rock Hill Events at which you will operate

Please select the Rock Hill Events at which you will operate

ChristmasVille - 300 Main St, Rock Hill, SC 29730

Food Truck Fridays - 300 Main St, Rock Hill, SC 29730

BMX Events - 1307 Riverwalk Pkwy, Rock Hill, SC 29730

Add additional sites within York County, SC

	Site Physical Address	Site Contact Name	Site Contact Phone Number
1	Add additional sites within York County, SC	Add additional sites within York County, SC	Add additional sites within York County, SC ext.
2	Add additional sites within York County, SC	Add additional sites within York County, SC	Add additional sites within York County, SC ext.
3	Add additional sites within York County, SC	Add additional sites within York County, SC	Add additional sites within York County, SC ext.
4	Add additional sites within York County, SC	Add additional sites within York County, SC	Add additional sites within York County, SC ext.
5	Add additional sites within York County, SC	Add additional sites within York County, SC	Add additional sites within York County, SC ext.

If additional space is needed for above events, please attach a detailed list of all events.

If additional space is needed for above events, please attach a detailed list of all events. Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

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SECTION C - Wastewater Discharge/Disposal Information

Check which best describes your current wastewater discharge

Check which best describes your current wastewater discharge

Commissary

Wastewater Treatment Plant

Other If other, type text here.

Wastewater Disposal Facility

Wastewater Disposal Facility

Physical Address (do not use PO Box)

Designated Facility Contact Name

Designated Contact Title

Designated Contact Phoneext.

Designated Contact Email

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SECTION D - Used Cooking Oil/Grease Recycling

Do you recycle the used cooking oil or grease produced at your facility?

Do you recycle the used cooking oil or grease produced at your facility?

Yes

No

Does your commissary provide this service?

Does your commissary provide this service?

Yes

No

If your commissary does not provide this service, what is the name of your recycling company?

If your commissary does not provide this service, what is the name of your recycling company?

Contractor Name

Physical Address of Used Cooking Oil Recycling Facility (do not use PO Box)

If your FSE has not implemented pollution prevention measures please visit www.cityofrockhill.com/fog for a copy of the City’s FOG Best Management Practices Manual.

Authorized Representative Statement:

I certify that I have read City of Rock Hill’s Fats, Oil and Grease Control Policy and understand that Food Service Establishments must NOT discharge fats, oil and grease to the City of Rock Hill’s sanitary sewer system or stormwater system.  Wastewater or UCO must NOT be disposed of in Restroom or Portable Restroom facilities.  Wastewater shall be flushed and drained only at the commissary.

I further certify under penalty of law that this document and all attachments were prepared under my direct 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/ or imprisonment for knowing violations.

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Authorized Representative Statement: I certify that I have read City of Rock Hill’s Fats, Oil and Grease Control Policy and understand that Food Service Establishments must NOT discharge fats, oil and grease to the City of Rock Hill’s sanitary sewer system or stormwater system. Wastewater or UCO must NOT be disposed of in Restroom or Portable Restroom facilities. Wastewater shall be flushed and drained only at the commissary. I further certify under penalty of law that this document and all attachments were prepared under my direct 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/ or imprisonment for knowing violations.

Applicant Name

Applicant Title

Applicant Email

After submitting this form, please upload any necessary documentation by clicking the link on the FOG webpage at cityofrockhill.com/fog

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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