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01/`11/2005 10: 18 9255340931 DILLARD TRUCKING PAGE 04 <br /> � A <br /> NON-HAZARDOUS WASTE MANIFEST <br /> Platso pet pr"a (Form d"gn.d for use or elite 12 kah ewpter <br /> NON-HAZARDOUS 1.Gnnarot*r'S US EPA ID No. fdlantf9st 2,Pape i <br /> WASTE MANIFEST Document No. <br /> os <br /> 3.GerA OaN=!a MaNInSiAddmsx M=T.ip Mgt Comm am 404"s nw. rLW <br /> ✓; if�'i <br /> 1619 ="aR L=w A.9, MrAw". tl3L, GI 9'169 <br /> 4,aenerwore Phone(' 9'1S 1"99-889y, <br /> ' 5,Tmnepnrter 1 Company Neenp B. U$EPA ID Number A.Stall Tteneporlera ID <br /> DiLY.i1RD ■VCB. CAD 9 d 2 S 23 -12 e.Transporter 1 Pb.. 925).634-SM <br /> " T.Tr.11'r,.panrn•$Company Name A. US EPA ID Numbw C.State TranspMera ID <br /> ' A,Deelgnalad FacilityD.TransporieF 2 Phon9llty Name end Site Addrasa 1p, UB EPA 10 Number E.State FadlVlys ID <br /> 1109 Aad M, <br /> 3a* VIS, A 9-4572 F.FaGllty°s Pnana <br /> ' <br /> 11.WA ��o 'ra -1t9 <br /> :J• b'T1:DEt3CRlt'TlflFl 1x. Came]nere 13. 14. <br /> Totd Unit <br /> N0. TYPe auamny vul.nrd. <br /> oc�p pkb5 a <br /> (i b. <br /> E <br /> E <br /> R <br /> 1A . <br /> O <br /> W R d, <br /> F <br /> Q.Aadit-1 DMrlptlone for Matapala Uoted Above <br /> H.Handling 1:etles for WaSigs Ua1ed Abave <br /> V? 115• <br /> 11cs <br /> 11d. <br /> a � <br /> SPeelal MAr1dIhAp InetrIX)VO d;and Adchlonel lnro"moon <br /> z Jab 1402 M C# . 2004 <br /> •F <br /> • AWMAW"AW"AWAWy�AWAWMAWAWAF <br /> ta.n Proper cantlllbe�nsMn.The ma faC tldaq nbad 01 Iib 01 <br /> am <br /> not sables)tDlf�dnd ccura jS dedw%ad <br /> and are In aA ngpe� <br /> repulBtlon0. <br /> DMO <br /> of <br /> 17.Transporter 1 Aalelarledpemmnf of pN Wpt aI Mtrl9rVals ma" 0 <br /> N p �� Slgnehna Data <br /> 12 S � A Marnh ]pay hhYaar <br /> 1$.TwmpotW 2 AofmuMedgem M d A9oalpl al MAdQdWe <br /> Pr"OdIFyppd Narny <br /> pDate <br /> 5lpnalwr9 <br /> R <br /> Adorrfn bay Year <br /> F 19.DISCrepRnry IndlrwSpama,Spam <br /> A <br /> C <br /> ,2101.17 iry Owner of Operator;GerlHkatton al reeoipf of the waste n"Wrlsfe eovntaA by thla rnant6 gl,grc <br /> .f � cepl ea noted M Item t a. <br /> T sort tvame. J `1 Date <br /> Y =Z4 <br /> s !- J gy h ar <br /> 200 <br /> CF14 d 2 I,ti![1J6fAST}>q W moos Caf.seoa'�_IaboMnaelAr.wm /Q (/ <br /> ®.A+rAnw.crurorvr.A. <br /> �AA91�C.41wAr �pjj�1 <br />