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HomeMy WebLinkAbout2019-11-19 Non-Hazardous Waste Manifest - Grease Interceptor - Walmart LIQUID ENVIRONMENTAL SOLUTIONS No. 6 2 0 7 ENVIRONMENTAL SOLUTIONS NON—HAZARDOUS WASTE MANIFEST GENERATOR INFORMATION Generator Name )v ecykey" %l;l X,) Contact Name Address 6.e.,\c' icy(1) j,c Phone City,State tr �, ' ► Zipc(, - Profile# Customer# 1—jCYy)e —�(() County Type of Trap: TiGrease Interceptor _Septic/Chemical Toilet _Grit/Sand Trap _Special X Outside _Inside _Non-Industrial _Industrial Trap Condition: Tank#1 ,)?,br) gallons Tank#2 O" 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, explosive,toxic or hazardous material('Excluded Waste').The term"hazardous materiar 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 Comprehensive Environmental 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 damages,costs,fines and liabilities resulting from or arising out of any such hazardous waste. Onginatar Name(Pnnted) Sgnature Date Time sEi keti TRANSPORT INFORMAT Company Liquid Environmental Solutions Driver Name Address 9199 Davenport Street NE Phone (763)784-6306 City,State Blaine,MN Zip 55449 State Registration# FOG Permit# Transporter Certification: I certify that the information above is accurate,and that only the waste certified for removal by the Generator is contained in the servicing vehicle. I am aware that falsification of this manifest may result in prosecution. Driver Name(Pnnted) Signatureate Time Cie L©t,,�� ytd i X11 i (4c - RECEIVERIDISPO AL INFORMATION Disposal Name Metro Liquid Waste Receiving Facility Contact Name Address 2400 Childs Road Phone (651)602-8393 city,State St.Paul,MN Zip 55106 County Ramsey EPD ApprovaVPenmit# NPDES# LAS# Solid Waste Handling# Industrial Pretreatment Permit# Total Quantity Received Gallons "7 goo 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. 'Disposal Name(Pnnted) Signature Date Time WRITE-TRANSPORTER YELLOW-DISPOSAL SITE PINK-GENERATOR January 2012 rev.r