!jf' - us epa4. generator's phone ( 61 forsyth st., i 1 th fl., sam nunn bid atlanta, ga...

Manifest !J<G'-Ot@t tlo. ....

2. 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


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



800-356-7457


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 ( )


Robbie D. Woods


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


800-356-7457


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


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


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~·


61 Forsyth St., i 1 th Fl., Sam Nunn Bid Atlanta, GA 30303

5. Transporter 1 Company Name Robbie D. Woods


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.


15. Special ~tel!ng Instructions and Additional Information

BCX Facility 1859 Ea~t Adams Street Jacksonville, Florida



800-356-7437



12.

01 TT 5200



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


9. Desigi).Qted FQcililY~ame andtSjfe AddresLLC vreemear Trea1men :serVIces 100 Waste Resfjlrch Drtve Macon, GA 31206


a.

b.

d.


15. Special Instructions and Additional Information



US EPA ID Number

10. US EPA ID Nurrober

GAR000007484

WASTEWATER

A. l"ran_spo_rter's Phone 800-3~6-7457


C. Facility's Pb.Qllll. 47ts-788-8899


Month Day Year


ORIGINAL -RETURN TO

..

Manifest 9'&~~ljo.

~ . . .

61 Forsyth St, 11Ut Fl., Sam Nunn Bid Atlanta, GA 30303


5. Transl'_orter 1 Com~any Name Robbie D. Woods


9. Designated Facili!Y Name and Site Address Greenleaf Treatment Services LLC 100 Waste Research Drive Macon, GA 31206


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



A.. Transporter's Phone 800-J~ 7457



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


61 Forsyth St., 11th Fl., Sam Nunn Bid Atlanta, GA 30303

5. Transporter 1 Company Name Robbie D. Woods




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.



BCX Fac:ility 1859 East Adams Street Jacksonville, Florida


A. Transporter's Phone 800-356-7457



12.


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


5. Transe_orter 1 Com_Eony Name ):{()bble D. Woods


9. Designated Facili!Y Name and Site Address Greenleaf Treatment Services LLC 100 Waste Research Drive Macon, GA 31206


US EPA ID Number


GAR00000'7~84

a. Non-Hazardous, Non-Regulated WASTE WATER Approval: 10347

b.

d.





2. Page 1

of 1

A. Transporter's Phone 800-3 56-7 457



12.

No.

01

__,.


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


5. Transe._orter 1 CoiT!£any Name I<obble D. WoOds


9. Design..Q.ted fQcilitv..Nome ond1S.i.te Addres~LC

tsreerueat· Treatmen :servtces L 100 Waste Research Drtve Macon, GA .31206


a.

Approval:

d.

D. Additional Descriptions for Materials Listed Above




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


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


5. Transe8rter 1 Com_Rony Name Kobble D. WoOds




US EPA ID Number


GAR00000'7484


d.





A. Transporter's Phone 800-356-7457



12.


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


5. Trans~0'6h/e <J~f'W~ame


9. oesi9~Me~~~J¥frcml~~ilr§~M~~sLLC 100 Wilste :Research Drive Macon, GA 31206


a.

Approval:

d.



BCX Facility 1859 East Adams Street JacksonviUe, Florida


A L ]jlbErffTrfS 9 1

US EPA 10 Number

10. US EPA 10 Number

GAR000007484

t.P

A. Tr11'~~1J5fe


C. Facility's ~~8S-S899

12.

No.

01


~-'

20. Facility Owner or Operator: Certification of receipt of waste materials covered by.this manifest except as noted in Item 19.

"

~· 1


5. T ronsef>rter 1 Com.P..qny Nome Hobble D. woOds

7. Transporter 2 Company Nome

100 Waste Research Drive Macon, GA 31206


61 Forgyth St., 11th Fl., Sam Nunn Bid Atlanta, GA 30303

US EPA 1D Number


GAR000007484


b.

d.

D. Additional Descriptions for Materials Listed Above


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


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

!jf' - us epa4. generator's phone ( 61 forsyth st., i 1 th fl., sam nunn bid atlanta, ga...

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