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04/28/2006 16:32 9313636694 SHANNON DOWNS PA(:,E F15 <br /> w <br /> N'ESSEE GENERAL CONSMUMON, INC. - ENVIRONMENTAL DIVISION <br /> 150 Robertson Hollow Road - Pulaski, TN 38A78 - (931) 363-5379 - www.tngeneml.com <br /> NON-HAZARDOUS WASTE MANIFEST <br /> EMERGENCY PHONE NUMBERS: (931)703-5379 -(931)309-8543 <br /> GENERATOR INFORMATION <br /> Business Name: `` WO#: <br /> Address J <br /> City: State —,-- Zip Phone: <br /> Waste From O/W/$: Grease Trap: Grit Trap: Other: r h <br /> I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, THE WASTE MATERIAL,REMOVED FROM THE ABOVE <br /> PREMISES CONTAINS NO HAZARDOUS MATERIALS. <br /> NAME(Please Print) <br /> A) <br /> Defiq'serviC96 Time <br /> COMMENTS: r � - <br /> TRANSPORTER INFORMATION <br /> Transporter Business Name: TENNESSEE GENERAL CONSTRUCTION INC. <br /> Address 150 RO ERTSON HOLLOW ROAD <br /> City: PULASKI State TN Zip 38478 Phone: 931-363-5379 <br /> Gallons Received: <br /> I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS CO E�T AND TH T ONLY THE TYPE WASTE SPECIFIED <br /> IS CONTAINED IN THE SERVICING VEHICLE. <br /> if cc <br /> 11VER NAIVE(Please Print) <br /> Da ervice Time out Signature <br /> DISPOSAL INFORMATION <br /> Business Name: t.'• f- 11. 1 <br /> Address .,1.> -'�� 1 i ` • 4, <br /> City: I. �. :,l _ State ... zip. <br /> ( ._! <br /> Gallons Received; <br /> { 1 <br /> Date W to Received <br /> Dispose!Site Operator's Signature <br /> Rejected: (Explain) <br /> Accepted: <br /> WHITE-ORIGINALCOPY CANARY-TRANSPORT COPY - PINK-OFFICE COPY • 00�0ENROD-GENERATOR HP 0 4139 <br />