HomeMy WebLinkAbout2020-07-17 Liquid Environmental Solution Non-Hazardous Waste Manifest - Grease Interceptorfir
E N' V PRO N M E N TA L
S 0 LU T 1 ON 5
LIQUID ENVIRONMENTAL SOLUTIONS No. 6 6 9,
GENERATOR INFORMATION
;E7jl,Generator Name
Address
City, State
Customer #
/<
Al
Zip Profile #
County
I ype of Trap: Z'Grease interceptor — Septio/ChernicalToilet — G ff,, Sand Trap _,'Special —,outside side
— Non -industrial — Industrial Trap Condition:
Tan, k #1 ?jb gallons Tank #2 gallons Service Frequency Weeks
Tank #3 gallons Tank #4 gallons
Generator Cerfification: I certify that the waste ,'Material rem,, oved from the above premises does not contain any radioactive, flammable,
explosive, toxic or hazardous material ("Excluded Waste" . The term ''hazardous material" is defined as any one or snore pollutant,
toxic substance, hazarrdous substance, solvent oroil .as defined in or pursuant t to the Resource'Conservation and Recovery Act, the
,Comprehensive EnVirorim entalResponse Compensation and LiabilityAct, the Federal Clean Water Act, orany other federal, state
or local environmental law, regulation,, ordinanceorrule, whether existing as of the date of this agree mfent or subsequently enacted
1also acknowledge that the Generator shall Ilse responsible for any costs incurred by th, e Transporter or Dish sal 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 airy and all damages, costs, fnes and liabilities resulting from or arising out of an, v such hazardous waste.
'Contact Name
Phone
•'ame''
R INFORKi
Company Liquid Environmental Solutions Driver Name
Address 9,199 Davenport Street NE Phone (763) 784-6306
city, state Blaine, MN Zip 55449
State registration #
FOG Permit #
Transporter Ceffffication: I certify that the irroun abon above is accurate, andth, at only the waste certified for rern oval by tfie 'Generator
,is contained in the servicing vehicle. I am aware that falsification of this manifestimay result in prosecution.
/'�?.ECE1VERftFV,,_ OSAL INFORMATION
Disposal Nam, e Metro Liquid Waste Receiving Facility Contact Na
,Address 2400 Childs Road Phonel
,city, state St Paul, MN
EPD Approval/Permit #
Solid Waste Handling #
zip 55106 County
NPDES #
Industrial Pretreatment Permit #
(651) 602-8393
Total Quantity Received Gallons 76
Cerfffication 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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