## NON - H AZA RDOUS WASTE MA NIFEST FOR OFFICE USE ONLY C ustomer Ace . No.

_ T I c ket No.

_ 

# I__ G

_ EN

_ E

_ R

_A

_T

_O

_ R

__ 

# WMI 890 0 5 2 Name 

## USEPAIMOI clo eOM Addre ss 

## 1800 Carillon Blvd. Cincinnati OH 45204 P h one No . 

### 2 1466s .. 8773 

# I WASTE C ODE 

# I 

# ~O~~~~



# I G e n e rating L ocati o n 

### 3519 PrOllidenc 

## Houston . TX 77020 State Gen . 10 No . 

### _N

_A

_ G e n . US EPA 10 No . 

## _ NA

_



# I QUANTITY 

# I UNITS 

# I

V 

# ,

I hereby ce rtify th at t he a bo ve listed material(s), is (are) no t a ha zardous w as t e as define d b y 4 0 CFR Part 261 or any applica b le s tate la w . T ha t . each was t e h as bee n pro perly des 9 ribed. classifi e d and pac ka g ed . a nd i s i n proper condition f or transpo rtation accordin g t o app li c a b le regulatio n s .



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AG E NTS NA ME ' ( PRIN T) / . ; DATE ,: S I GNATURE

Trans p o rter's Name 

## Waste Management ~ Pas a dena Addres s 

### 3520 Pansy 

## Pasadena, TX 77505 I herebYJ Ce rt i fy tj hat the a bove lis t ed mat ~ ~ al was 9 ic k ed u p at t r e Generat or site lis t ed above and delive/ red w ithou t inci dent to the dis ~ o s a l faci li ty li &ted be l ow . 

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# I " '" , l ' ) , ( 1 I (1 I . , '. , /-" . l -: ) " 1 • . • 

### 1 ,j f SHI PM E NT DATE ' DRIVER'S S IGNATURE - ( DELIVERY D ATE DRIVER ' S S I GNATU ,

Si te N ame 

## Coastal Plains ROF Addr ess 

### 21000 East 

## Hwy 6

1721~A Pe r mi t No.

_ P hon e No. 

### (281)388- 17 08 

## Alvin T.X 77511

### WM USA Environmental Serv ice s Date: Truck #

3520 Pansy Manifest # ~/k 

# 1.~" , ( _1 

### Trailer # , 

## , 

# - , Pasadena, T exas 77 5 0 5 MAS Ticket # Van 

### # 281 - 48 7 -5000 F ax 2 8 1-99 8 - 158 0 Driver Name Tanker # Customer Name: , -I 

## I PO# Address: City l State 

# '. i w " 

## . TriD Oriein: Load Destination (', 

### Time Schedule Time am pm Time am pm Clock In , 

### Clock Out Fro m To 

# . From To Pre - Trip ,- 

### Po s t Trip Lunch Other Other Other 

# . Time D iso atc hed Customer L ocatio n Odometer State

, 

### Arrival Time II 

## I I ; I, 

### Stop Ti c ket Departure Time Beginning Miles

Comments: ,,' 

### , - 

## , Start Tic ket
" 

### Reas o n Stop Ticket Disposal Site

Arrival Time Start Ti c ket Departure Time

Comments: Rea s on
Ti me Compl eted Customer L oc atio Q

Arrival Time 

# I I I Departure Time Ending Miles Comments:
T otal M i les LOAD TYPE (circle . one) .. . EIR D NR SIO 

### DEL BTY FFY LIV ' TRP REL FYN NO LOAD Liner (circle answ er) 

### I Yes· 

### I No 

## I C lo th 

### I Plastic Box Info B ox # In Out " 

### Box Condition Wm Box i . 

### ~c . 6 r 

### On DeL O K D amage On Pick Up v 

### TarpslRol l Pipe Cu s to mer Box Holes Bows Rental Box Ratchet s Other 

# "- Shippers Printed Name Consienee's Sipature Driver's Signature 

## G E NERA T OR

_._ ••• • &i: : £:, "':e.t:tY berM.. 'en • • • • dE' "Custome r Summary R e port

C r iteria: 0 4 1 0 61 2 009 1 2 : 00 AM t o 04 10912009 1 1:59 PM Bus i ness Unit N ame: Co as t al Plains Landfill - B01073 (USA) User : cmorga 1 Date : Apr 09 2009, 9 : 58: 57 AM - Central Standard TIme Opera ti on Ty p e : A ll Custome r Name : ENV I ROQ M G M T ( E N VIRONMENTAL QUAUTY MANAGE M ENT) TIcke t Typ e : All Custome r Type: All PMT Category : All Ticket Date 4f7flfJ09 Mat er ia l Total Customer To t a l T i c ket Tot a ls 889544 1 1 1