HomeMy WebLinkAbout2024-06-19 Liquid Environmental Solutions - Non-Hazardous Waste Manifest (Grease Interceptor) Manifest#24060604921
ENVIRCNNENIAI
5 0l U 5 0 0 5 LIQUID ENVIRONMENTAL SOLUTIONS
Pc Innovctive
NON-HAZARDOUS WASTE MANIFEST
Name Contact Name
PAN ERA BREAD#606100
Address Phone
13535 60TH STN 6513239021
City,State Zip County
OAK PARK HEIGHTS,MN 55082
Customer# Profile ft
42745100319 #N/A
Tank#1(gallons) Tank#2(gallons) Service Frequency
800 0 8
Tank#3(gallons) Tank 44(gallons)
0 0
Generator Certification:I certif•the waste material'tenoved horn the above premises 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 Environment Response Compensation and Liability Act,the Federal Clean Water Act,or any other leder al state or local envimmental law,regulation,ordinance,or rule,whether
existing as oldie date of this agreement or subsequently enacted.I also acknowlege that the Generator shall he responsible for any costs incurred by the Transporter or Disposal Facility in handling or
proper disposal of any hazardous waste and that the Cienerator expressly agrees to dehatd.indemnify and hold harmless the Transporter hom and against any and all damages,costs,fines and liabilities
vaulting from arising out of any such hazardous caste.
Originator Signature Date Time
PANERA BREAD#606100 06/19/2024 03:41 L36 PM
TRANSPORTER INFORMATION
Company Driver Name
Liquid Environmental Solutions KASEY HARRELL
Address Phone
9199 DAVENPORT ST
City.State Zip State Registration#
BLAINE,MN 55449
Transporter Certification:I certify that the intimation above is accurate,and that only the waste certified for removal by the generator is contained in the servicing vehicle.lain aware that
ralsiCation of this manikst may result in pros suction.
I)ri ver Name Signature (late 'rime
KASEY HARRELL /' 06/19/2024 03:41:47 PM
RECEIVER/DISPOSAL INFORMATION
Disposal Name Contact Name
METROPOLITAN SEWER-MN
Address Phone
2400 CHILDS RD
City,State Zip County
SAINT PAUL MN 55106
Route,t.'CDFA Manifest# Total Quantity Rccieved Gallons
011<11 800
Certification of Receipt:The above waste was receive)by the facility within the property boutalarie;and will be prowsul,disposed ot;or recycled in accordance with all applicable knvs.
Facility Representative Signature Date Time
METROPOLITAN SEWER-N 06/19/2024 03:41:44 PM