HomeMy WebLinkAbout2018-06-18 Non-Hazardous Waste Manifest - Grease Interceptor - Walmart I
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LIQUID ENVIRONMENTAL SOLUTIONS No. 3 8 0 9
ENVIRONMENTAL
SOLUTIONS NON-HAZARDOUS WASTE MANIFEST
GENERATOR INFORMATION
Generator Name v.11(;¢41442..r */8// Contact Name
• Address 58 I S e_ll vag/ Phone
City,State t) l//liv r /eiri zip S.SI)8e2 Profae#
Customer# ya yi59-0e016. - County
Type of Trap: tsGrease Interceptor —Septic/Chemical Toilet _Grit/Sand Trap -_Special _Outside _Inside
_Non-industrial _Industrial . Trap Condition:
• Tank#1 CD3 gallons • Tank#2 /3 gallons Service Frequency Weeks
Tank#3 gallons Tank#4 gallons
Generator Certification: I certify that the waste material removed from the above premises does not contain any radioactive,flammable,
I explosive,toxic or hazardous material('Excluded Waste'). The term°hazardous material"is defiled as any one or more pollutant,
toxic substance,hazarrdous substance,solvent or oil as defined in or pursuant to the Resource Conservation and Recovery Act,the
Comprehensive Envkohmental Response Compensation and Liability Act,the Federal Clean Water Act,or any other federal,state
• or local environmental law,regulation,ordinance,or rule,whether existing as of the date of.this agreement or subsequently enacted. .
I also acknowledge that the Generator shall be responsible for any costs incurred by the Transporter or Disposal Facility in handling or
proper disposal of any hazardous waste and that the Generator expressly agrees to defend,indemnify and hold harmless the Transporter
from and against any and all dam s,costs,fines and liabilities resulti or arising out of any such hazardous waste.
. . Originator Name(Pnnted) lure Date Time
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TRANSPORTER INF RM N
. Company Liquid Environmental Solutions Driver Name
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Address 9199 Davenport Street NE Phone (763) 784-6306 City,State Blaine, MN Zp 55449
State Registration# FOG Permit#
•
T -. -.orter Certification: I certify that - ormation above is accurate,and that only the waste certified for removal by the Generator -
• cont.fined in the servicing vehicle. I a ' :.that talsdication of this manifest may result in prosecution.
I I -r'ame 'nnt- S7T
. are Date Time
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R'CEIVE' •ISPOSAL INFORMATION
Diss• - Name Metro Liquid r aste Receiving Facility Contact Name -
••••ress 2400 Childs Road Phone (651)602-8393
City,State St. Paul, MN Zip 55106 County Ramsey
•
EPD Approval/Permit# NPDES# LAS#
. Solid Waste Handling# Industrial Pretreatment Permit#
f.
Total Quantity Received Gallons
Certification of Receipt: The above waste was received by this facility within the property boundaries and will be processed,disposed
ot,or recycled in accordance with all applicable laws.
Disposal Name(Printed) Signature Date Time
f.
WHITE-TRANSPORTER YELLOW-DISPOSAL SITE PINK-GENERATOR
January 2012 rev.1
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ENVIRONMENTAL
Summary
SOLUTIONS
Clean. Reliable_ Innovative_
Customer SUPERCENTER#1861
Customer 5815 NORELL AVE, STILLWATER, MN 55082
Address
Customer ID 424159-00062
Trans Unit .x" MINTRANS Route ID MINRScotT0206
Service Date 2/6/2018 12:00:00 AM FST ID ' 410730
Service Call# 180202-0340 FST ROBERT SCOTT
Grease Trap/ Trap Location Line Jet? ' Grease and Top Grease Middle Water ' Lower Sludge
LES Trap ID Solids% Layer(In r= Layer(In ,Layer(In
Inches) Inches) Inches)
QT-GRTR SIDE RIGHT No 4 1 48 1
94410
QT-GRTRJ2] BACK No 4 1 48 1
94409 CENTER