HomeMy WebLinkAbout2023-08-03 Liquid Environmental Solutions - Non-Hazardous Waste Manifest (Grease Interceptor) Manifest#23080905061
ENVIRONMENTAL
SOL r I C•N 5 LIQUID ENVIRONMENTAL SOLUTIONS
NON-HAZARDOUS WASTE MANIFEST
Name Contact Name
PAN ERA BREAD#606100
Address Phone
13535 60TH STN 6513239021
City,Stale Zip County
OAK PARK HEIGHTS,MN 55082
• Customer# Profile#
42745100319 #N/A
Tank#I(gallons) Tank#2(gallons) Service Frequency
800 0 8
'I ark#3(gallons) Tank#4(gallons)
0 0
Generator Certification:I certify the waste material removed tom the above promises does not contain any radioative,flammable,explosive toxic or hazardous material("Excluded Waste").The
term"hazardous","materials'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 Environmerrt Response Compensation and Liability Act,the Federal Clean Water Act,or any other ideral state or local envinmtental law,regulation.ordinance,or rule,whether
existing as of the date ofthis agtun rent or subsequently enacted.I also aclmowlege that the Generator shall be responsible fir any costs incurred by the Transporter or Disposal Facility in handling or
pmlxr disposal of any hazardous waste and that the Generator expressly agrees to dotard.indemnify and hold harmless the Transporter limn and against any and all damages,costs,fines and liabilities
resulting from arising out of any such hazardous waste.
Originator Signature Date Time
PANERA BREAD#606100 08/03/2023 11:35:45 AM
TRANSPORTER INFORMATION
Company' Driver Name
Liquid Envi oiuiental Solutions JUSTIN MII J FR
Address Phone
9199 DAVENPORT ST
City.State Zip State Registration#
BLAINE,MN 55449
Transporter Certification:I=tit;that the intimation above is accurate,and that only the waste certified fir removal by the generator is contained in the servicing vehicle.I are aware that
filsikation of this manifest may result in procesution.
Dri ver Name Signature Date Time
JUSTIN MILLER 08/03/2023 11:3630 AM
RECEIVER/DISPOSAL INFORMATION
Disposal Name Contact Name
METRO LIQUID WASTE
Address Phone
2400 CI IILDS RD
City,State Zip County
SAINT PAUL,MN 55106
Route,I CD FA ManiEst)t Total Quantity Recieved Gallons
02JM 800
Certification of Receipt:The above waste was received by the facility within the property boundaries and will be processed,disposed of;or recycled in accordance with all applicable laws.
Facility Representative Signature Date Time
LES-HOUSTON-TX 08/03/2023 113626 AM