HomeMy WebLinkAbout2022-08-30 Liquid Environmental Solutions - Non-Hazardous Waste Manifest (Grease Interceptor)Route/SC ID
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ENVIRONMENTAL
SOLUTIONS
LIQUID ENVIRONMENTAL SOLUTIONS No. 8629
NON -HAZARDOUS WASTE MANIFEST
GENERATOR INFORMATION
Generator Name U-�� ey4q � 1 66 1 Contact Name
Address i j&Ied 4ye Phone
City, State �, ?,it �� zip Profile#
Customer # Ll 4 a In MD (" Z__ County
Type of Trap: SGrease Interceptor _ Septic/Chemical Toilet _ Grit/Sand Trap _Special ZOutside _ Inside
_ Non -Industrial _ Industrial Trap Condition:
Tank #1 gallons Tank #2 2CC4) 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 material' 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.
TRANSPORTER INFORMATION
Company Liquid Environmental Solutions Driver Name
Address 9199 Davenport Street NE
City, State Blaine, MN zip 55449
State Registration #
Transporter Certification
Phone (763) 784-6306
FOG Permit #
I certify that the information above is accurate, and that only the waste certified for removal by the Generator
s contained In the servicing vehicle. I am aware that falsification cl this manifest may result in prosecution.
r1 er Name Ante Ig ure Date Time
i�-2
I[C%0C1 V GIV IJIJrVJAL IIVI-Vniviik i ION
Disposal Name Metro Liquid Waste Receiving Facility Contact Name
Address 2400 Childs Road
City, State St. Paul, MN
EPD Approval/Permit #
Solid Waste Handling #
Zip 55106
NPDES #
Phone (651) 602-8393
County Ramsey
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.
Wril I t - I KiilvJrUK I tK Y tLLUvv - U1bF USAL 511 t PINK - GENERATOR
January 2012 rev.1