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HomeMy WebLinkAbout2022-03-29 Non-Hazardous Waste Manifest - Grease Interceptor - Walmart Route/SC ID 220401-0386 • e.. -maciz , ,,:-.J2 u i-as»,r L� ENVIRONMENTALSOLUTIONS7 V©. °,:J .1. «.� :. ] ! _•tet i , C MANIFEST GENERATOR INFORMATION Generator Name " '' f�'( h Contact Name sAddress { r �. `_. h! 0 E Phone I City, State d\ "Ic -ec— Zip QZ Profile 9 4 Customer# `q1 {c' Ii County Type of Trap: XGrease Intercepter Septic/Chemical Toilet __Grit/Sand TrapI p Special Outside Inside Industrial Trap Condition Tank#1 cC gallons Tank#2 ii 0 gallons Tank#3 __._ gallons Tank#4 ----- gallons Service Frequency Weeks Ii Generator Certification: I certify that the waste material removed from the above premises does not contain any radioactive,flammable, 1 explosive, toxic or hazardous material ("Excluded Waste'). The term"hazardous materiar 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 4 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 re proper disposal responsible for any costs incurred by the Transporter or Disposal Facility in handling or b p 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. •riginator Name (printed ignature late Ime I TRANSPORTER INFORMATION Company Liquid Environmental Solutions Address 9199 Daven784 port Street NE Driver Name Phone {763 -6306 l f 1 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 b l the Generator is contained in the servicing vehicle. lam aware that falsification of this manifest ma Y 'Driver Name (printed) Signet e Y result in p.r osecutien. Date Time RECEIVER/DISPOSAL INFORMATION 4 Disposal Name Metro LiquidWest e iR pPivin Facility Contact Name Address 2400 Childs Road Phone (651)602-8393 City, State St, Paul. MN EPD Approval/Permit# NPDES# rp m County Ramsey Solid Waste Handling# LAS# Industrial Pretreatment Permit# Total Quantity Received Gallons 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(printed) ignat late _ - , le.,\ !me -2- i --a WHITE-TRANSPORTER YELLOW-DISPOSAL SITE PINK-GENERATOR