180 non hazardous waste manifest 2017 ■
LIQUID ENVIRONMENTAL SOLUTIONS No. 38 41
ENVIRONMENTAL
SOLUTIONS NON-HAZARDOUS WASTE MANIFEST
GENERATOR INFORMATION
DIVISION 1#2901
Generator Name Contact Name
Address 180 N KING ST Phone
City,State NORTH HAMPTON, MA Zip 0 1060 Profile#
Customer# 40808311 County
Type of Trap: *Grease Interceptor _Septic/Chemical Toilet _Grit/Sand Trap _Special _Outside _Inside
_Non-Industrial _Industrial Trap Condition:
Tank#1 ( l Q b gallons Tank#2 gallons Service Frequency Weeks
Tank#3 gallons Tank#4 gallons
1GentratOe Certification:Customer warrants that food waste or wastewater collected by Contractor will not contain any radioactive,flammable,explosive,chemical,toxic or
hazardous material("Excluded Waste").The terry"hazardous material"means any one or more Pollutant,toxic substance,hazardous waste,hazardous material,hazardous
f abstonce,solvent or ail as defined in or pursuant to the Resource Conservation and Recovery Act,as amendea,the Comprehensive Environmental Response,Compensation and
LiabilityAci.or amended,the Federal Clean Water Act,as amended,nr any other Federal,Stateor local env'ronmental low,regulation,ordinance,or rule,whether existing as of
tine dote of this Agreement or subsequently enacted.In oddit ion,Customer acknowledges that their waste materials may be suitable for energy and nutrient recovery through
anaerobic digestion or other recycling applications and therefore agrees to exclude contaminants to these recycling programs from their waste materials.Contaminants ore
defined as,but not limited to:seprage,septic holding tank wastes,sevroge,or sludge;industrial wastes,and more than incidental volumes of inerts,such as silverware,plastics,
and other garbage.For purposes of organics recycling,only food scraps and food production wastes may be Included.Contractor shall acquire title to the Waste Material after it is
loaned into Contractor's couectlan vehicle;provided,however,title to and liability for Excluded Waste shall remain with Customer at all times.Customer shall be responsible for
one costs incurred by Contractor in the noodling o•proper disposal of any Excluded Waste and Customer expressly agrees to defend,Indemnify and hold harmless Contractor f rom
end against any and oli damages.costs,'asses,penalties,fines and liabilities resulting from or arts/no out of any such Excluded Waste.
Originator Name(Printed) Signature DateTime
..-., (�/1 iia,/,7 //..60
NSPORTER INFORMATION
Company Liquid Environmental Solutions Driver Name
Address 527 Pleasant Street Phone 508-236-6001
City,State Attleboro, MA Zip 02703
State Registration# N/A FOG Permit# N/A
Transporter Certification: I certify that the information above is accJrate,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 Name(Printed) Signature Date Time
L-1.' as----- L-L___fr------ 1-3)1-7 //e) D
B GREEN ENEit`G CM/ER/DISPOSAL INFORMATION SHANNON CARROLL
Disposal Name 14-BARSFOW E Contact Name 914-914-319S
Address Phone
HADIIY,MA
City,State Zip County
EPD Approval/Permit# NPDES# LAS#
Solid Waste Handling# Industrial Pretreatment Permit#
Total Quantity Received Gallons
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 alt applicable laws.
Disposal Name(Printed) Signature Date Time
WHITE-TRANSPORTER YELLOW-DISPOSAL SITE PINK-GENERATOR
January 2012 rev.1
! r
Work Completion Form
ENVIRONMENTAL
SOLUTIONS
Clean. Reliable_ Innovative.
'Customer DIVISION 1 #2901
Customer 180 N KING ST, NORTHAMPTON, MA 01060
Address
(Customer ID 408083-00411
'Trans Unit ATBTRANS FST ID 210404
Service Date 7/13/2017 12:00:00 AM Route ID ATBEBotT0713
Service Call# 1 7071 3-01 34
Grease Trap/ Trap Location Line Jet? Grease and Top Grease Middle Water Lower Sludge
LES Trap ID Solids% Layer(In Layer(In Layer(In
Inches) Inches) Inches)
QT-GRTR Front Center No 4 1 46 1
800071
Is the customer available? Is the customer able to inspect?
Customer Questionnaire
Have you inspected the work?
Were safety cones used?
Is the area around the trap dean?
Are trap lids secured and closed?
Was disruption to business minimized?
Did we meet your expectation?
Customer Signature
Customer Printed Name
Customer Title
FST ERIC BOTELHO