HomeMy WebLinkAbout2020-11-20 Liquid Environmental Solutions - Non-Hazardous Waste Manifest (Grease Interceptor) Route/SC ID
201119-0329
* u 1 U LIQUID ENVIRONMENTAL SOLUTIONS No. 7 614
NON-HAZARDOUS WASTE MANIFEST
GENERATOR INFORMATION S
-_ R.Z.,22e7--'erator Name ( ru Q �G�/GC Contact Name
a
. ._,dress / 3 5 1 5i- Al Phone i
:.71;/, State �t s )3 -i //7/-5-- / /ZAJ Zip S5 G' Profile#
I
:,:stor~er# 2/4.74/5/_ 6%6)3// County ` 1
7-%:::,e of Trap: GGrease Intercepter Septic/Chemical Toilet Grit/Sand Trap Special Outside _Inside I
_ Non-Industrial Industrial Trap Condition
__ ^`K #1 ,:"z gallons Tank#2 gallons
- #3gallons Tank#4
�' `" gallons Service Frequency Weeks
Qenerator Certification: I certify that the waste material removed from the above premises does not contain any radioactive,flammable,
ax�'csve. toxic or hazardous material ("Excluded Waste"). The term "hazardous material" is defined as any one or more pollutant,
t.ox:c substance,hazardous 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 1
c. local environmental law,regulation,ordinance,or rule,whether existing as of the date of this agreement or subsequently enacted. 1
e:so acknowledge that the Generator shall be responsible for any costs incurred by the Transporter or Disposal Facility in handling or f
- =per disposal of any hazardous waste and that the Generator expressly agrees to defend,indemnify and hold harmless the Transposer I
cm,and against any and all damages,costs,fines and liabilities resulting from or arising out of any such hazardous waste.
-..1Thginator Name (printed) Signature Date Time
( f
TRANSPORTER INFORMATION 1
Company Liquid Environmental Solutions Driver Name t
:dress 9199 Davenport Street NE Phone (763)784-6306 1
",'y. State Blaine, MN Zip 55449 t
3,-.ate Registration# FOG Permit#
Transporter Certification: I certify that the information above is accurate, and that only the waste certified for removal by
.rre Generator is contained in the servicing vehicle. I am aware that falsification of this manifest may result in prosecution.
Iver Name (printed) / 7 Signatures'; Date Time i
0,-?,,, (2.5 `-�,.f-r,// f�c�'7,7c �c - .- / l�—//— ) ,4 6'x'1
t ELVER/ SPOSAL INFORMATION
2 s,posal Name Metro Liquid Waste Receiving Facility Contact Name
• cdress 2400 Childs Road Phone (651) 602-8393
State St. Paul. MN Zip 55106 County Ramsey
Approval/Permit# NPDES# LAS#
_lid Waste Handling# Industrial Pretreatment Permit#
-T tai Quantity Received Gallons e=tom
Certification of Receipt: The above waste was received by this facility within the property boundaries and will be processed,
_sccsed of, or recycled in accordance with all applicable laws.
2osai Name (printed) Signature Date Time
WHITE-TRANSPORTER YELLOW•DISPOSAL SITE PINK-GENERATOR