HomeMy WebLinkAbout2024-03-28 Liquid Environmental Solutions - Non-Hazardous Waste Manifest (Grease Interceptor) � •' Manifest#24022005252
:,,R,nkFut
I IQUID ENVIRONMENTAL SOLUTIONS
NON-HAZARDOUS WASTE NIANW ST
Name
Contact Name
PANERA BREAD#606100
Address Phone
13535 60T11 STN 6513239021
City.State Zip County
OAK PARK HEIGHTS,MN 55082
Castome Profile ft
42745100319 #N/A
Tank sl(gallons) Tank 42(gallons) Service Freyuenos
0 0 8
I ank 43(gallons) Tank 04(gallons)
0 0
Generator Certification:1 artily the waste material removal Isom the above premises does not contain any nachoative,flammable.eexplosive,toxic or hazardous material("Excluded Waste").The
;earn"hazardou ',"matirials"is defined as atv one or inure pollutant.toxic substance,hazardous substance,solvent or oil as defined in or pursuant to the Resource Conservation and Recovery Act,
the Cnn I.ehensn e 1-.nvi mnnment Response C onlnasation and Liability Act,the Federal Cleanµata Act,or any other federal state or local e vinnnerntal late,rev._dation ordinance,or rule,whether
c.istin us oldie dale of this agreement or subsquertly enacted.I also acknowiegc that the Generator shall be responsible hr any costs insured by the Transporter or Disposal Finality in handling or
proper disposal of any hazardous waste and that the Generator expressly agrees to dehtd indemnify and hold harmless the Transporter fmm and against any and all damages,costs,fines and liabilities
resulting from anisinz out nfany such War-dons waste
(Idntit for Signature Date Time
PANERA BREAD#606100 03/28/2024 03:25:49 PM
TRANSPORTER INFORMATION
C'onnpanv Iii ver Nance
Liquid Erirorintntal Solutions KASEY HARRELL
Address Phone
9199 DAVENPORT ST
City.State Zip State Registration#
BLAINE,MN 55449
Transporter Certification:I cenih that the inknmation aboue is accurate,and that only the waste certified'hr removal by the generator is contained in the servicing vehicle.f am aware that
Etisi tatton of this mauifest may result in procesuction.
Dicer Name Signature Date Time
KASEY HARRELL 03/28/2024 0326:18 PM
RECEIVER/DISPOSAL INFORMATION
Disposal Name Contact Name
METROPOLITAN SEWER-MN
Address Phone
2400 C 1>ILDS RD
State Zip County
SAINT PALL MN 55106
Route,(I DFA Sianitst Total Quantity Roiea'ed Gallons
0K 0
Certification of Raetipt:The above waste was receivd by the finality within the property boundaries and will be processed,disposal of or recycled in accordance with all applicable laws.
Foci lily Represartatire Sivature Date Time
METROPOLITAN SEWER-1V 03/28/2024 03:26:15 PM