HomeMy WebLinkAbout2024-04-11 Liquid Environmental Solutions - Non-Hazardous Waste Manifest (Grease Interceptor) Manifest#24022005253
ENVIPCNM=NT,.
LIQUID ENVIRONMENTAL SOLUTIONS
NON-HAZARDOUS WASTE MANIFEST
Fame Contact Name
PANERA BREAD#606100
Address Phone
13535 60111 STN 6513239021
City.Stale Zip County
OAK PARK HEIGHTS,MN 55082
Cnsronx'r- Profile d
42745100319 #N/A
Tank tl(gallons) Tank 52(gallons) Service Frequence
800 0 8
Tank*3(gallons) Trunk a4(gallons)
0 0
Generator Certification:I cettily the waste material removed torn the above premises does not contain any radioative,flammable.explosive.toxic or hazardous material("Excludai Waste').The
term"hazvdots"."inatcriala'is defined as any one or more pollutant toxic substance.hazardous substance,solvent or oil as defined inn or pursuant to the Resource Conservation and Recovery Act,
the Comprdterr ire Environment Response Compensation and Liability Act,the Federal Clean Water Act,or any other federal state or local errsinnnental tat.regulation,ordinance,or rule,whether
existing as ofrhe nate cut this agreement or subsequently enacted.I also acknortege that the Generator shall be responsible for airy costs incurred by the Transporter or Disposal Facility in handling nr
proper disposal of any hazardous waste rind that the Generator expressly agrees to defard,indemnify and hold harmless the Transporter from and against any and all damages,costs,fines and liabilities
resulting front aiming oil orally such hazardous,waste.
(hi ei nae or Signature Date Time
PANERA BREAD#606100 04/11/2024 01:26:53 PM
TRANSPORTER INFORMATION
Company Driver Name
Liquid Ern*onmental Solutions JUSTIN MILLER
Address Phone
9199 DAVENPORT ST
City.State Zip State Registration i#
BLAINE,MN 55449
Transporter Certification:I certify that the inknm:uion above is accurate,and that only the waste unified to removal by the generator is contained in the servicing vehicle.I am awme that
tdsikation of this manlist may result in procesuctton.
Dive-Name Signature Date Time
JUSTIN MILLER - 04/11/2024 01:26:18 PM
RECEIVER/DISPOSAL INFORMATION
Ihspysal Name Contact Nannie
ME 1 ROPOLITAN SEWER-MN
Address Phone
2400 CHILDS RD
('ity.Slate Zip Cowny
SAINT PAUL,MN 55106
Route 0 CDFA Nl:umikst Total Quantity Rcieved(zrllons
02JM 800
Certification of Receipt:The above waste was receival by the futility within the property boundaries and will be processed,disposed of or recycled in accordance with all applicable laws.
PaciIity R resctrtative Signature Date Time
METROPOLITAN SEWER-1V - . 04/11/2024 01:26:13 PM