HomeMy WebLinkAbout2023-12-29 Liquid Environmental Solutions - Non-Hazardous Waste Manifest (Grease Interceptor) Manifest#23092803771
ENVIRONMENTAL
SOLUTIONS LIQUID ENVIRONMENTAL SOLUTIONS
Cleo,Rehablc Innovative.
NON HAZARDOUS WAS TEMANIFEST
Name Contact Name
PANERA BREAD#606100
Address Phone
13535 60TH ST N 6513239021
City,State Zip County
OAK PARK HEIGHTS,MN 55082
Customer# Profile#
42745100319 #NIA
Tank#1(gallons) Tank#2(gallons) Service Frequency
800 0 8
Tank#3(gallons) Tank#4(gallons)
0 0
Generator Certification:I certify the waste serial removed fom the above penises does not contain any radioative,laminable,explosive,toxic or hazardous material("Excluded Waste").The
tarn"hazardous","materials"is defiled 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 Environment Response Compensation and Liability Axl,the Federal Clean Water Act,or any other€laal state or local arvimmental law,regulation,ordinance,or rule,whether
existing as of the date of this agreement or subsequently enacted.I also admowlege that the C ralauor shall be responsible fir 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 defect,indemnify and hold harmless the Transporter fom and against any and all damages,costs,fiches and liabilities
resulting font wising out of any such hazardous waste.
Originator Signature Date Time
PANERA BREAD#606100 / 12/29/2023 11:19:06 AM
TRANSPORTER INFORMATION
Company Driver Name
Lkiuid Fnviroiiugrnal Sohrtions KASEY HARRELL
Address Phone
9199 DAVENPORT ST
City,State Zip State Registration#
BLAINE,MN 55449
DEPOT
Tranapottex Certification:I certify that the infmnation above is accurate,and that only the waste certified fir removal by the generator is contained in the servicing vehicle[am aware that
filsifation of this manifest may result in proc suction.
Driver Name Signature Date Time
KASEY HARRE . f A 12/29/2023 11:19:37 AM
RECEIVER/DISPOSAL INFORMATION
Disposal Name Contact Name
METROPOLITAN SEWER-MN
Address Phone
2400 CHILDS RD
City,State Zip County
SAINT PAUL,MN 55106
Route#/CDFA Matifst# Total Quantity Recieved Gallons
OIKH 800
ACTIVE
Certification of Receipt:The dove waste w.s raxival by the fcility within the property boundaries and will be pnxzssal,disposal of or recycied in auwda to with all applicable laws.
Facility Representative Signature Date Time
METROPOLITAN SEWER-N. v/ 12/29/2023 11:1931 AM