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4330 Deans Bridge Road – GA 30805 (706) 592-3200 – Fax (706) 592-1658 www.augustasolidwaste.com SOLID WASTE DEPARTMENT ASBESTOS DISPOSAL MANIFEST FORM I. PROJECT INFORMATION ASBESTOS PROJECT: PROJECT ADDRESS: CITY: ZIP: REMOVAL CONTRACTOR: ADDRESS: CITY: LICENSE NO: NO: II. WASTE HAULER INFORMATION WASTE HAULER COMPANY: ADDRESS: CITY: LICENSE NO: NO: Signature of Driver Date III. LANDFILL INFORMATION Landfill Name: ____________Augusta-Richmond County Solid Waste Permit Number: D (SL) / 121-018 D (MSWL) Volume Asbestos Received: LN/FT. Type of Containers: Condition of Containers: Were Containers Labeled (Asbestos Waste): EPA/OSHA/DOT: Yes: No: I CERTIFY THAT Augusta-Richmond County Solid Waste Facility HAS BEEN APPROVED FOR THE DISPOSAL OFASBESTOS-CONTAINING MATERIAL AND THAT THE DELIVERED MATERIAL WILL BE DISPOSED IN ACCORDANCE WITH LOCAL, STATE, AND FEDERAL REGULATIONS. Signature of Landfill Operator Date Cell Grid Location Please Complete and return original and one copy. REV: 05/01/2007