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Manifest !J<G'-Ot@t tlo. ....
2. Page 1 of 1
61 Forsyth St, 11th Fl., Sam Nunn Bid Atlanta, GA 30303
Generator's Phone (
5. Transporter 1 Company Nome Robbie D. Woods
7. Transporter 2 Company Nome
9. Designated Facility Nome and Site Address Greenleaf Treatment Services LLC 100 Waste Research Drive Macon, GAJ1206
11.
a.
d.
D. Additional Descriptions lor Materials Listed Above
15. n.ll,lnstructions and Additional Information .t'acility
1859 East Adams Street Jacksonville, Florida
19. Discrepancy Indication Space
US EPA ID NuiTiber
.A ;L p 9 ~ 7.1 ~ 8. 8.9 ~ US EPA ID NuiTiber
10. US EPA ID
GAROOOO 7484
A. Transporter's Phone
800-356-7457
B. Transporter's Phone
C. Facility's Phone 478-788-8899
E. Handling Codes lor Wastes Listed Above
SITE: !Jf'.l r:M_,·hty BREAK: &. 1~ OTHER: ~~ I
\ \
I
' ' \ 11111111111111111111111111111111111111111111111111 .. 10445681
20. Facility Owner or Operator: Certification of receipt of waste materials by this monif•lst except as noted in Item 19.
Printed/Typed Nome
~,.rc.-. Signature v '""\_-/' Year oy
ORIGINAL -RETURN TO GENI:RA TOR
4. Generator's Phone (
61 Forsyth St., lltb Fl., Sam .Nunn Bid Atlanta, GA 30303
5. Transporter 1 Company Name
Robbie D. Woods
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
Greenleaf Treatment Services LLC 100 Waste Research Drive Macon, GA 31206
11. Waste Shipping Name and Description
US EPA ID Number
.A .L P () (! 7 .1 3 ~ 8 .9 l US EPA ID Number
10. US EPA ID Nurr.ber
GAR000007484
a. Non-Hazardous, Non-Regulated WASTE WATER App.roval: 10347
b.
c.
d.
D. Additional Descriptions for Materials listed Above
15 .. Special ~f31!ng Instructions and Additional Information
BCX Facility 1859 East Adams Street Jacksonville, Florida
19. Discrepancy Indication Space
A. Transporter's Phone
800-356-7457
B. Transporter's Phone
C. Facility's Phone
478-788-8899
12.
E. Handling Codes for Wastes listed Above
Month Day <Year
20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature
ORIGINAL -RETURN TO GENERATOR
,~--~ -------------- ------------
NON-HAZARDOUS WASTE MANIFEST
3. Generator's Name and Mailing Address
4. Generator's Phone ( )
5. Transporter 1 Company Name
Robbie D. Woods
7. Transporter 2 Company Name
I :Jy ?enerator's US EPA ID No.
p,.D_98:219976.1 . . , U SEP A .Keg10n 4 - .I:SCX
61 Forsyth St., llrh Fl., Sam Nunn Bid Atlanta, GA 30303
6. US EPA ID Number
I .A .L P 9 ~ 7.1 3 ~ 8 .9 l 8. US EPA ID Number
I 9. Designated Facility Name and Site Address
Greenleaf Treatment Services LLC 100 Waste Research Drive
10. US EPA ID Nunober
2. Page 1 I of 1
A. Transporter's Phone
800-356-7457
B. Transporter's Phone
C. Facility's Phone
478-788-8899
1-----Ma_co_n_, c_A_JI_2_06 ________ _..-o"__,_,..~.I_G_A_R_o_o_o_o_o __ 7_4_8_4_--L----.-------.-------.,------1i 11. Waste Shipping Name and De~_cription ~- 12. Containers 13. 14. :
a.
G b. E N E
'-'' Total Unit No. Type Quantity_ Wt/Vol
Ntm-Hazardous, Non-Regunated WASTE WATER Approval: 10347 01 TT 5200
Rr-----------------------------------------------------------------~----~--~--------~--~ A c. T 0 R
d.
D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above
15. Special mreY!ng Instructions and Additional[nformation
BCX Facility 1859 East Adams Street Jacksonville, Florida
16. GENER_ATOR'S CERTIFICATION: I certify the materials described above on this manifest oro not subject to federal regulations for reporting proper disposal of Hazardous Waste. ,, T R A N s p 0 R T E R
F A c
r;d/Typed Name
u Rit>Jr3 'I (;t< W>1t?VJ l/5 c' .. Pos e-tt-17. Transp_s>rter 1 Acknowledgement of Re~eipt of Materials
~Tl!Nze ;/ .~ V.,./~
18. Transporter 2 Acknalledgement of Receipt of Materials
Printed/Typed Name
19. Discrepancy Indication Space
I Signatu:L., k- -1-:FTJL V-.S. /EPA JVsc..- Month Day Year
~ "• l lt'.912...11 ~~ , A - A
ISig~~L~ Month Day Year
~-9l2'·/lo-~ , .. .,. -7, I Signature Month Day Year
I · I · I · -
I ~------------~--------------------------------------------------------------------------------------~ L 20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manife!t except as noted in Item 19. I
~~--------------------------------------------~-------------------------------------------------------~ Printed/Type_,d Name ~Signature
~"\ r-c, V'---'rt J v c...----~~J KELLER & ASSO;:IATES,INC.
elii~l~tt:54957·0368 .
.. ,:1
- ......,. --
Manifest
8.CW~"Qt !i~·
4. Generator's Phone (
61 Forsyth St., i 1 th Fl., Sam Nunn Bid Atlanta, GA 30303
5. Transporter 1 Company Name Robbie D. Woods
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address Greenleaf Treatment Services LLC 100 Waste Research Drive Macon, GA 31206
11. Waste Shipping Nome and Description
US EPA ID Nun1ber
.A .L p 9 ~ 7.1 ~ ~ 8 .9 J US EPA ID Nu"'ber
US EPA ID Nu"'ber
GAR000007484
0. Non-Hazardous, Non-Regulated WASTE WATER Approval: 10347
b.
d.
D. Additional Descriptions for Materials listed Above
15. Special ~tel!ng Instructions and Additional Information
BCX Facility 1859 Ea~t Adams Street Jacksonville, Florida
19. Discrepancy Indication Space
A. Transporter's Phone
800-356-7437
B. Transporter's Phone
C. Facility's Phone 478-788-8899
12.
01 TT 5200
E. Handling Codes for Wastes listed Above
20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in Item 19.
Manifest
~'&~~tSl~·
61 Forsyth St, 11th Fl., Sam Nunn Bid Atlanta, GA 30303
4. Generator's Phone ( "fD't ) ~bZ. • t!Jl'i Q
5. Trans~rter 1 Com.J.!c:>ny Name Kobble D. woOds
7. Transporter 2 Company Name
9. Desigi).Qted FQcililY~ame andtSjfe AddresLLC vreemear Trea1men :serVIces 100 Waste Resfjlrch Drtve Macon, GA 31206
11. Waste Shipping Nome and Description
a.
b.
d.
D. Additional Descriptions for Materials listed Above
15. Special Instructions and Additional Information
BCX Facility 1859 East Adams Street Jacksonville, Florida
19. Discrepancy Indication Space
US EPA ID Number
10. US EPA ID Nurrober
GAR000007484
WASTEWATER
A. l"ran_spo_rter's Phone 800-3~6-7457
B. Transporter's Phone
C. Facility's Pb.Qllll. 47ts-788-8899
E. Handling Codes for Wastes listed Above
Month Day Year
20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in Item 19.
ORIGINAL -RETURN TO
..
Manifest 9'&~~ljo.
~ . . .
61 Forsyth St, 11Ut Fl., Sam Nunn Bid Atlanta, GA 30303
4. Generator's Phone (
5. Transl'_orter 1 Com~any Name Robbie D. Woods
7. Transporter 2 Company Name
9. Designated Facili!Y Name and Site Address Greenleaf Treatment Services LLC 100 Waste Research Drive Macon, GA 31206
11. Waste Shipping Nome and Description
US EPA ID Number
10. US EPA ID Number
GAR00000'7484
a. Non-Hatzardous, Non-Regulated WASTE WATER Approval: 10347
d.
D. Ad\:litional Descriptions for Materials listed Above
15. Special &tel!ng Instructions and Additional Information
BCX Facility 1859 East Adams Street Jacksonville, Florida
19. Discrepancy Indication Space
A.. Transporter's Phone 800-J~ 7457
B. Transporter's Phone
C. Facility's Phone 478-788-8899
E. Handling Codes for Wastes Listed Above
20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest oxcept as noted in Item 19.
12-BLC-M5
v -· ---- ---,-------~"""";<====~---------------
Manifest 9~1@~t'J'Io.
0 0 0
4. Generator's Phone (
61 Forsyth St., 11th Fl., Sam Nunn Bid Atlanta, GA 30303
5. Transporter 1 Company Name Robbie D. Woods
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address Greenleaf Treatment Services LLC 100 Waste Research Drive Macon, GA 31206
11. Waste Shipping Name and Description
US EPA ID Number ALD067138891 .........
US EPA ID Number
10. US EPA 10 Number
GAR000007484
a. Non-Hatzardous, Non-Regulated WASTE WATER Approval: 10347
b.
c.
d.
D. Additional Descriptions for Materials listed Above
15. Special Instructions and Additional Information
BCX Fac:ility 1859 East Adams Street Jacksonville, Florida
19. Discrepancy Indication Space
A. Transporter's Phone 800-356-7457
B. Transporter's Phone
C. Facility's Phone 478-788-8899
12.
E. Handling Codes for Wastes listed Above
Month Day Year
20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest "xcept as noted in Item 19.
Manifest
~c&~~ttJ~·
61 Forsyth St, 11th Fl., Sam Nunn Bid AUanta, GA 30303
4. Generator's Phone (
5. Transe_orter 1 Com_Eony Name ):{()bble D. Woods
7. Transporter 2 Company Name
9. Designated Facili!Y Name and Site Address Greenleaf Treatment Services LLC 100 Waste Research Drive Macon, GA 31206
11. Waste Shipping Nome and Description
US EPA ID Number
10. US EPA ID Number
GAR00000'7~84
a. Non-Hazardous, Non-Regulated WASTE WATER Approval: 10347
b.
d.
D. Additional Descriptions for Materials listed Above
15. Special Instructions and Additional Information
BCX Facility 1859 East Adams Street Jacksonville, Florida
19. Discrepancy Indication Space
2. Page 1
of 1
A. Transporter's Phone 800-3 56-7 457
B. Transporter's Phone
C. Facility's Phone 478-788-8899
12.
No.
01
__,.
E. Handling Codes for Wastes listed Above
20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest e,;cept as noted in Item 19.
12~BLC-M5
Manifest 9<8ul}~t,.o .
• 0 ••
3. 61 Forsyth St, 11th Fl., Sam Nunn BJd Atlanta, GA 30303
4. Generator's Phone (
5. Transe._orter 1 CoiT!£any Name I<obble D. WoOds
7. Transporter 2 Company Name
9. Design..Q.ted fQcilitv..Nome ond1S.i.te Addres~LC
tsreerueat· Treatmen :servtces L 100 Waste Research Drtve Macon, GA .31206
11. Waste Shipping Nome and Description
a.
Approval:
d.
D. Additional Descriptions for Materials Listed Above
15. Special Instructions and Additional Information
BCX Facility 1859 East Adams Street Jacksonville, Florida
19. Discrepancy Indication Space
US EPA ID Number
10. US EPA ID Number
GAR00000'7484
A. Tran_spo_rter's Phone 800-356-7457
8. Transporter's Phone
C. Facility's 4~~~88-8899
E. Handling Codes for Wastes listed Above
Month Day Year
20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest e<cept as noted in Item 19.
- -- - ----~~----~--~--==~0~.~~---------------------------~~-----
Manifest 9~Q)el'(Jio.
61 Forsyth St., 11th F!., Sam Nunr: Bid Atlanta, GA 30303
4. Generator's Phone (
5. Transe8rter 1 Com_Rony Name Kobble D. WoOds
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address Greenleaf Treatment Services LLC 100 Waste Research Drive Macon, GA 31206
11. Waste Shipping Nome and Description
US EPA ID Number
10. US EPA ID Number
GAR00000'7484
a. Non-Hazardous, Non-Regulated WASTE WATER Approval: 10347
d.
D. Additional Descriptions for Materials listed Above
15. Special Instructions and Additional Information
BCX Facility 1859 East Adams Street Jacksonville, Florida
19. Discrepancy Indication Space
A. Transporter's Phone 800-356-7457
B. Transporter's Phone
C. Facility's Phone 478-788-8899
12.
E. Handling Codes for Wastes listed Above
Month Day Year
20. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest e><:ept as noted in Item 19.
3. 61 Forsyth St, 11th Fl., Sam Nunn Bid Atlanta, GA 30303
4. Generator's Phone (
5. Trans~0'6h/e <J~f'W~ame
7. Transporter 2 Company Name
9. oesi9~Me~~~J¥frcml~~ilr§~M~~sLLC 100 Wilste :Research Drive Macon, GA 31206
11. Waste Shipping Name and Description
a.
Approval:
d.
D. Additional Descriptions for Materials listed Above
15. Special Instructions and Additional Information
BCX Facility 1859 East Adams Street JacksonviUe, Florida
19. Discrepancy Indication Space
A L ]jlbErffTrfS 9 1
US EPA 10 Number
10. US EPA 10 Number
GAR000007484
t.P
A. Tr11'~~1J5fe
B. Transporter's Phone
C. Facility's ~~8S-S899
12.
No.
01
E. Handling Codes for Wastes listed Above
~-'
20. Facility Owner or Operator: Certification of receipt of waste materials covered by.this manifest except as noted in Item 19.
"
~· 1
4. Generator's Phone (
5. T ronsef>rter 1 Com.P..qny Nome Hobble D. woOds
7. Transporter 2 Company Nome
100 Waste Research Drive Macon, GA 31206
11. Waste Shipping Nome and Description
61 Forgyth St., 11th Fl., Sam Nunn Bid Atlanta, GA 30303
US EPA 1D Number
10. US EPA ID Number
GAR000007484
a. Non-Hazardous, Non-Regulated WASTE WATER Approval: 10347
b.
d.
D. Additional Descriptions for Materials Listed Above
15. Special Instructions and Additional Information
BCX F aciJity 1859 East Adams Street Jacksonville, Florida
19. Discrepancy .triC!icotion Space
A. Trons]lorter's Phone 800-356-7457
B. T ronsporter's Phone
C. Facility's Phone 478-788-8899
E. Handling Codes for Wastes Listed Above
Month Day Year
20. Facility Owner or Operator: Certification of receipt of waste· materials covered by this manifest except as noted in Item 19.
ORIGINAL -RETURN