HomeMy WebLinkAbout2017-05-08 Liquid Environmental Solutions - Non Hazardous Waste Manifest I
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LIQUID ENVIRONMENTAL SOLUTIONS No. 4 2 7 0 I
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ENVIRONMENTAL
SOLUTIONS
NON-HAZARDOUS WASTE MANIFEST )
GENERATOR,�tINFORMATION
Generator Name - tc -4-ec4/i.% Contact Name
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Address 58‘s 5blorea pie Phone s
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_ City,Statet\t�(�tZip S508aProfile#
Customer# S V/S9_¢ 1oa County I
1) Type of Trap:. LiGrease Interceptor _Septic/Chemical Toilet _Grit/Sand Trap _Special "Outside _Inside ii
Non-lndusirial _Industrial Trap Condition: ie
'V.' Tank#1 ,/ljy/ gallons Tank#2 2ice gallons Service Frequency Weeks l
Tank#3 gallons Tank#4 gallons 5
Generator Certification: I certify that the waste material removed from the above premises does not contain any radioactive,flammable,
LI explosive,toxic or hazardous material("Excluded Waste"), The term"hazardous material"is defined 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
—.C. Comprehensive Environmental Response Compensation and Liability Act,the Federal Clean Water Act,or any other federal,state f
or local environmental law,regulation,ordinance,or rule,whether existing as of the date of this agreement or subsequently enacted. r
cji I also acknowledge that the Generator shall be responslole 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 t
from and against any and all damages,costs,fines and liabilities resulting from or ' ing out of any such hazardous waste. E
Onginator Name(Printed) signature1 -Date Time
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T NSPORTER FORMAT ON i.
Company Liquid Environmenta Solutions Driver me f ,. a
Address 9199 Davenport Street NE Phone
p (763) 784-6306
City,State Blaine, MN Zip 55449 }
State Registration# . . FOG Permit#
• Transporter Certification: I certify that nto =ton above is accurate,and that only the waste certified for removal by the Generator
is contai d in the servici vehicle. I a aware to,-t falsif .f alis manifest may result in prosecution:. . .,
Driver (Printed) Si. .I • 7,t/o. Tie
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"ECEIVER/DISPOSAL INFORMATION
Disposal Name Metro Li ,id Waste Receiving Facility Contact Name •
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Address. 2400 Childs ' •ad . , Phone (651) 602-8393 ii
City,State St.•Paui, MN • Zip 55106 County Ramsey
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EPD Approval/Permit# NPDES# LAS#
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Solid Waste Handling# Industrial Pretreatment Permit#
Total Quantity Received Gallons 0a1.0____ ,
Certification of Receipt: .The above waste was received by this facility within the property boundaries and will be processed,disposed
of,or recycled in accordance with all applicable laws.
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Disposal Name(Printed)..: . Sigiature Date Time
-'i 4 a- rr i vi- .� c�ur�a�
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WIFE-TRANSPORTER YELLOW-DISPOSAL SI INK- ENERATOR t
January 2012 rer.1
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Service Summary
ENVIRONMENTAL
SOLUT10NS
Crean- Relrable. Innovative_
Customer SUPERCENTER#1861
Customer 5815 NORELL AVE, STILLWATER, MN 55082
Address
Customer ID 424159-00062
Trans Unit MINTRANS Route ID MINRSco180508
Service Date 5/8/2018 12:00:00 AM FST ID
Service Call# 180501-0374 FST robert
Grease Trap i Trap Location Line Jet? Grease and Top Grease Middle Water Lower Sludge,
LES Trap ID Solids°A) Layer(In Layer(In Layer(in
Inches) Inches) Inches)
QT-GRTR_[21 BACK No
94409 CENTER
QT-GRTR SIDE RIGHT No
194410