Pumper Checklist
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Interceptor Operating at: __________________________________________ (Enter Facility Name)
Address: __________________________________________
__________________________________________
__________________________________________
Serviced By (Name):
_______________________________
Company: __________________________________________________________
Company Contact (Tel): _______________________________
About this Pump-Out:
Service Date: _______________________________
Format:
❑
Remote Pump
❑
Full Access (Covers Removed)
Last Full Access Pump? ______________________________
Note: At a minimum of every 3rd remote pump or twice annually (whichever is sooner) full access cleaning and
inspection is required.
Interceptor Fully Pumped (Water/FOG & Solids):
❑
Yes
❑
No
Approx. Volume of Waste Removed: _____________________ Gallons/Liters
Inlet Baffle Opened/Inspected
❑
Yes
❑
No
Flow Control Checked/Cleaned
❑
Yes
❑
No
Note: The flow control device (internal or external), shall be inspected and cleaned a minimum of every 3rd
pump or twice annually (whichever is sooner)
Cover(s) secured on completion of Pumping?
❑
Yes
❑
No
Important Note: If covers are in an area that is accessible to the public, always check to ensure that covers are
fully secured even if you did not remove the cover(s) as part of this pump-out.
Any Concerns, Issues or Comments to Report: _____________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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Pumper Checklist:
