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    Manifest Form

    Uploaded by

    anonymous
    This manifest form documents the collection and transport of sludge from a residential property in Nueva Ecija to a treatment facility in Pangasinan. [1] It lists Jose S. Salviejo Jr. as the household owner and provides the collection address. [2] Clean Liquid Enterprises collected approximately 1 cubic meter of residential domestic waste on February 9, 2023. [3] The form is signed by the operator, driver, and household owner to acknowledge satisfactory service and transport of the waste to L.E. Radam Enterprises treatment facility in Pangasinan for chlorination.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Manifest Form

    Uploaded by

    anonymous
    73 views1 page
    This manifest form documents the collection and transport of sludge from a residential property in Nueva Ecija to a treatment facility in Pangasinan. [1] It lists Jose S. Salviejo Jr. as the household owner and provides the collection address. [2] Clean Liquid Enterprises collected approximately 1 cubic meter of residential domestic waste on February 9, 2023. [3] The form is signed by the operator, driver, and household owner to acknowledge satisfactory service and transport of the waste to L.E. Radam Enterprises treatment facility in Pangasinan for chlorination.

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    Manifest-form

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    This manifest form documents the collection and transport of sludge from a residential property in Nueva Ecija to a treatment facility in Pangasinan. [1] It lists Jose S. Salviejo Jr. as the household owner and provides the collection address. [2] Clean Liquid Enterprises collected approximately 1 cubic meter of residential domestic waste on February 9, 2023. [3] The form is signed by the operator, driver, and household owner to acknowledge satisfactory service and transport of the waste to L.E. Radam Enterprises treatment facility in Pangasinan for chlorination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    73 views1 page

    Manifest Form

    Uploaded by

    anonymous
    This manifest form documents the collection and transport of sludge from a residential property in Nueva Ecija to a treatment facility in Pangasinan. [1] It lists Jose S. Salviejo Jr. as the household owner and provides the collection address. [2] Clean Liquid Enterprises collected approximately 1 cubic meter of residential domestic waste on February 9, 2023. [3] The form is signed by the operator, driver, and household owner to acknowledge satisfactory service and transport of the waste to L.E. Radam Enterprises treatment facility in Pangasinan for chlorination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    MANIFEST FORM Control Number: STD-02-09-23-01

    (V. 2022) (Local Code-MM-DD-YY-Order of the Day)

    SLUDGE/SEPTAGE ORIGIN:
    Name of Household/Unit Owner: SALVIEJO, JOSE S. JR. Meter Number: ____________

    Address: #86, CASULUCAN, SANTO DOMINGO, NUEVA ECIJA


    SOURCE & VOLUME OF SLUDGE/SEPTAGE
    ( ) Residential ( ) Commercial ( ) Institutional ( ) Wastewater Treatment Plant
    Date of Collection: 02-09-2023 Time of Collection: _________ Volume of Septage Collected (cubic meters): ___________

    Commercial/industrial waste must be sampled and tested before it is off-loaded at the treatment facility to ensure that
    the material won’t contaminate the treatment process. Contamination can be caused by grease, oil, metals, and
    chemicals.

    Description of Commercial/Industrial Waste: _____________________________________________________________


    Residential Domestic Waste
    __________________________________________________________________________________________________

    EXCAVATOR/TRANSPORTER:
    Operator: CLEAN LIQUIDENTERPRISES
    L.E. RADAM PHILIPPINES, INC. Address: Caanawan
    San Bartolome,
    BRGY. Sta.SUAL,
    San Jose
    PANGASCASAN Ana,PANGASINAN
    City, Pampanga
    Nueva Ecija Contact #: 0967 392 7405
    0917-242-1745
    Plate Number: ___________ Type of Vehicle: _____________________________Driver’s
    Elf Truck License #: ________________
    Name of Driver: _____________________________________________________Signature:_______________________
    Name of Team Member #1: ___________________________________________ Signature: _______________________
    Name of Team Member #2: ___________________________________________ Signature: _______________________

    I hereby acknowledge and certify accomplishment of the siphoning service to my satisfaction.

    ______________________________
    Signature of Household/Unit Owner

    Attested by Barangay Captain or Authorized Representative: ______________________________


    (Name and Signature)

    (To be accomplished by Treatment/Disposal Facility)

    TREATMENT/DISPOSAL FACILITY:
    Name of Treatment/Disposal Facility: _______________________L.E. RADAM ENTERPRISES_______________________
    UAL PANGASINAN_______________
    Address of Treatment/Disposal Facility: ________________BRGY. PANGASCASAN SAUL,
    Date Received: ___________ Time Received: ____________ Type of Treatment/Disposal: _____CHLORINATION_________

    _________LEOCILA E. RADAM_________
    Signature over Printed Name of the
    Authorized Representative

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