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04/28/2006 16:32 9313636694 SHANNON DO4QNS PAGE 04 <br /> 50 103 <br /> TENNESSEE GENERAL CONSTRUCTION, INC. - EL'1VIRMMONTAL DIVISION <br /> 150 Robertson Hollow Road • PulosI6, TN 38478 • (931) 363-5379 ■ www.tngeneral.com <br /> NON-HAZARDOUS WASTE MANIFEST <br /> EMERGENCY PHONE NUMBERS: (931)7033379• (931)309-8543 <br /> GENERATOR INFORMATION <br /> Business Name: f1�c4 �� 7 C:2�L?�`� WO#: L/ <br /> Address X11),44 18n,2 <br /> City: � State Zip 4 - �(, Phone: SF� Jt1 I <br /> Y . <br /> Waste From O/WIS: Grease Trap: Grit Trap: Other: ; __ <br /> I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE,THE WASTE MATERIAL RENIOVED FROM THE ABOVE <br /> PREMISES CONTAINS NO HAZARDOUS MATERIALS. <br /> „^NE(Please Print) <br /> Gatti S arvlTime In -I. S <br /> _ azure <br /> COMMENTS: <br /> TRANSPORTER INFORMATION <br /> Transporter Business Name: TENNESSEE GENERAL CONSTRUCTION INC. <br /> Address 150 ROBERTSON HOLLOW ROAD <br /> City: PUL.ASKI State TN Zip 38478Phone: 931-363-5379 <br /> Gallons Received: <br /> I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS CORRECT AND THAT ONLY THE TYPE WASTE SPECIFIED <br /> IS CONTAINED IN THE SERVICING VEHICLE. <br /> RIVER N (Pleame Print) <br /> Da a Tlma Out signature <br /> DISPOSAL INFORMATION <br /> Business Name: S@E, General ConstuC#lOn Inc. <br /> Address 150 Robertson Hollow Road <br /> City; Pulaski State Zip <br /> Gallons Received: <br /> Data <br /> W"Received Disposal Ste Opergtot's Signature <br /> Rejected; (Explain) Accepted: <br /> WHITE-ORIGINAL COPY r, -TRANSPORT COPY PINK.OFFICE COPY • GOLbENROD•GENERATOR HP 4 4130 <br />