180 GreaseTrap Manifest 2017 III Si
LIQUID ENVIRONMENTAL SOLUTIONS No. 3 8 41
ENVIRONMENTAL
SOLUTIONS NON-HAZARDOUS WASTE MANIFEST
GENERATOR INFORMATION
DIVISION 1#2901
Generato-Name Contact Name
Address 180 N KING ST Phone
City,State NORTH HAMPTON, MA Zip 0 1060 Profile#
Customer# 408083-00411 County
Type of Trap: *Grease Interceptor _Septic/Chemical Toilet _Grit/Sand Trap _Special Outside _Inside
_Non-Industrial _Industrial Trap Condition:
Tank#1 1 i Q b galions Tank#2 gallons Service Frequency Wee KS
Tank#3 galions Tank#4 gallons
Generator 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 term"hazardous material"means any one or more pollutant,toxic substance,hazardous waste,hazardous material,hazardous
substance,solvent or all as defined in or pursuant to the Resource Conservation and Recovery Act,as amended,the Comprehensive Environmental Response,Compensation and
Liability Act,as amended,the Federal Clean Water Act,as amended,or any other Federal,Statear local environmental low,regulation,ordinance,or rule,whether existing as of
the date of this Agreement or subsequently enacted.In addition,Customer acknowledges that their waste materials may be suitable for energy and nutrient recovery through
anaerobic digestion or other re.-ycling applications and therefore agrees to exclude contaminants to these recycling programs from their waste materials.Contaminants ore
defined as.but not limited to:septage,septic holding tank wastes,sewage,or sludge;industrial wastes;and more than incidental volumes of inerts,such as silverware,plastics,
and other garbage.Far purposes of organics recycling,only food strops and food production wastes may be included.Contractor shall acquire title to the Waste Material after It Is
loaded into Contractor's collection vehicle;provided,.however,title to and liability for Excluded Waste shall remain with Customer at all tines.Customer shall be responsible for
any costs Incurred by Contractor in the handling or proper disposal of any Excluded Waste and Customer expressly agrees to defend,indemnify and hold harmless Contracto,from
and against any and all damages,costs,losses,penalties,fines and liabilities resulting front or Dosing out of any such Excluded Waste.
Originator Name(Printed) Signature -Date Time
.,., (> ?Jig/i7 /l..d -
NSPORTERINFORMATION
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 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 Name(Primed) Signature Date Tune
L"Y ` t3, -V'--- 71+3h-7 HO U a
B GREEN ENERI6CEIVERIDISPOSAL INFORMATION SHANNON CARROLL
Disposal Name Contact Name
24-BARSTOW LANE 914-924-3195
Address Phone
HADLEY,MA
City,State Zip County
EPD ApprovalfPermit# 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 all applicable laws.
Disposal Name(Printed) Signature Date Time
WHITE•TRANSPORTER YELOW-DISPOSAL SITE PINK-GENERATOR
January 2C'2 rev.1
■ S
Work Completion Form
ENVIRONMENTAL
SOLUTIONS
Cleon. Reboble. Innoratire.
!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# 170713-0134
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)
OT-GRTR Front Center No 4 1 46
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 clean?
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