HomeMy WebLinkAbout2022-03-29 Liquid Environmental Solutions - Non-Hazardous Waste Manifest (Grease Interceptor) Route/SC ID
220310-0940
ii Q.4 P U LIQUID ENVIRONMENTAL SOLUTIONS .
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:501... TIONS NON-HAZARDOUS WASTE MANIFEST
_. /� GENERATOR INFORMATION
Generator Name - i/ ; 1/ t
'r !- Contact Name
Address
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�n Phone
City. State . tt_(
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Customer# A'. t�,' Zip - Profile#
/�^` County
Type of Trap: Grease intercepter Septic/Chemical Toilet Grit/Sand Trap p Special Outside _ Inside
industrial Trap Condition
Tank#1 r gallons
gallons Tank#2g
Tank#3 ---------
gallons Tank#4 gallons Service Frequency Weeks
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 material'is defined as any one or more pollutant,
toxic 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
or
or local environmental law,regulation,ordinance,or rule,whether existing as of the date of this agreement or subsequently
I also acknowledge that the Generator shall be responsible for any costs incurred bythe Transporter enacted.a
proper disposal of any hazardous waste and that the Generator expressly agrees to defend,indemnifyandhold Facility
the Transporter
from and against any and all damages,costs,fines and liabilities resulting from or arisingout of an
originator Name printe.) Y such hazardous waste.
ignature sate
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TRANSPORTER INFORMATION
Company Liquid Environmental Solutions
r Address 9199 Davenport Street NE Driver Name
City, State Blaine. MN 1763) 8.— 4"f"'-3iJ6
Zip 55449
State Registration# Phone
FOG Permit#
Transporter Certification: I certify that the information above is accurate, and that only the waste certified for removal
the Generator is contained in the servicing vehicle. I am aware that falsification of this manifest
,s river Name(printed) may result in prosecution.
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RECEIVER/DISPOSAL INFORMATION
II
It Disposal Name Metro Liquid Waste Receiving Facility Contact Name
Address 2400 Childs Road
City, State S#, Paul, Phone (651)602-8393
EPD Approval/Permit# NPDES#Zip 551136 County Ramsey
Solid Waste Handling# LAS#
Total Quantity Received Gallons Industrial Pretreatment Permit#
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.
s isposa Name(printe•)
ignature sate
ire
WHITE-TRANSPORTER __.. .
YELLOW-DISPOSAL SITE PINK-GENERATOR