180 Wast Manifest 2016 LIQUID ENVIRONMENTAL SOLUTIONS No. 1223
ENVIRONMENTAL
SOLUTIONS
NON-HAZARDOUS WASTE MANIFEST
GENERATOR INFORMATION
Generator Name I1v,��iOt4 ! ` ' i��
J�.{l tik vvi.PTOI`i j ►Yt ZiP o{
Address
City,State
Customer#
Type of Trap: *Grease Interceptor SepticJChemicol Toilet
Non-Industrial industrial
Tank#1
Tank#3
9do
gallons Tank#2
gallons Tank#4
Contact Name
Phone
Profile#
County
Grit/Sand Trap ___Spacial Outside Inside
Trap Condition:
gallons Service Frequency Weeks
gallons
Genera tar Certification:Customer warrants that fool waste a wastewater collected by Contractor will not contain any Paarnwble;explosive,chemical toxic or
,'rosserious snore-no,("Ext!uded Waste').The tetra Isar ardour mdterlal'means any One ormore pollutant toxic subsumed,hazardous waste,hazardous material,hazardous
esubstonK,solvent or oil as defined in as pursuant to the Resource Conservaton and Recovery Act,as amended,ere Comprehensive Environmental Response!Compensation and
iiandisyACL as emended,the Federal Clean Weter'Aet,as amended,or any other Federal,Stotws,io[at environmental tow,regulation,ordinance.or rb-ie,whether es sting as of
Ott dote of this Agreement or subsegutentty enacted.in addition,Customer acknowledges that their waste rratenals may he tunable for energy and nutrient recovery through
preamble digest on or other eIra:no applications and therefore agrees to exclude contominonts to these recyct ng programs from their waste materials.Contaminants are
rdefined as,but not:sorted t0:storage,septic trading tone wastes,sewage.or stodge;industrial wastes;and more than Incidental colonies of inerts,such as silverware.plastics,
'end other garbage.For purposes of organics recycling,only food scraps and food production wastes may be included.Contract's shall acquire titir to the Late Material after it is
Iroadrd into Cantnsctoes collection vehicle;provided,however,title to and liability for Excluded Waste shad remain with Customer at all times Lbstomer shall be responsible far
ay costs incurred b y Contractor In the handling rw p r o p e r disposal of oni E x c l u d e d Waste and t:dsmmer expressly agrees t o d e f e n d,i n e l e m h i)j and hold harmless Contra,for fi m
pad ago:hst any and ad damages,costs,losses,penalises;fines and Nchlldies resetting from or ansrng out of trap such Excluded Waste.
Originator Name{Rimed} Signature
trte Time
TRANSPORTER INFORMATION
Company Liquid Environmental Solutions Driver Name
Address 527 Pleasant Street
City,state Attleboro, MA 'zip 02703
State Registration# NIA
Phone 508-236-6001
FOG Permit# N/A
Transporter Certification: I certify that the information above is accurate,and that only the waste certified for removal by the Generator
is contained in the servicing vehicle. I am aware that falsification of this manifest may result in prosecution.
Driver me(Ponied) ,Signature
Disposal Name
Address
City,State
RECEIVE
Date
/4 -'E a/c2 V�
ISPOSALORMATION
(_7 CA 61'1_41
14 40 LE- rig A Zip
EPD ApprovaliPermit# NPDES#
Solid Waste Handling#
Contact Name
Phone
County
Industrial Pretreatment Permit#
Time
7:1A/4.1
11
cll.-y 31gc
LAS#
Total Quantity Received Galons
Certification of Receipt: The above waste was received by this facility within the property boundaries and will be processed,disposed
of,or recycled in accordance with all applicable laws.
Crisposai Name( rinfed) Sgnature
D ie
Time
Wire-TRANSPORTER
YELLOW-DISPOSAL SITE
PINK-GENERATOR
January 2012 rev.'
!Act
Quarterly inspection Form
jt . Outdoor in-Ground Grease Interceptor
Date of Inspection: inspectors Title: Dr'vcei
Inspectors Name: Vi r) fi(lcrt Inspectors Signature:ac.
7-7
A written log of all quarterly inspections is required to be maintained cm site for a period of 5 years for kitchen wastewater traselvarges.
Grerall depth of fats, oils,grease and food waste ffeet/inches)T
3y
Describe. any maintenance vet or changes in equipment associated'with
slac:.1 discharge since the last inspection I 6- z) 0
Describe anT.' correctire acrim.s
• fii 1 6-1 6 0
(I) The gln-ase mterceptcd must be cleaned Virhencvez 25%of the operating depth is nem/pied by FOG and sevied
solids or a minirnum of every 3 months whidiever is more frequent
Comments: (provide any additional information regarding inspection obserirsuions,maintenance.,and service activity)
,) 0
leviu—mifrur 0/1/1"Sielu.„1- #0??so I
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