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4330 Deans Bridge Road – GA 30805 (706) 592-3200 – Fax (706) 592-1658 www.augustasolidwaste.com SOLID WASTE DEPARTMENT NON-HAZARDOUS MANIFEST WASTE GENERATOR DESCRIPTION OF WASTE UNIT OF MEASURE CONTAINER/TRUCK TYPE I hereby certify that the above-described materials are not hazardous waste as defined by 40 CFR Part 261 or any applicable state law, have been fully and accurately described, classified, and packaged, and are in proper condition for transportation according to applicable regulations. Generator Authorized Agent Name (Print) Signature Delivery Date WASTE TRANSPORTER DESTINATION SITE NAME: AUGUSTA –RICHMOND COUNTY LANDFILL PHONE NUMBER: [PHONE REDACTED] ADDRESS: 4330 Deans Bridge Road Georgia Ticket Number Tonnage Disposal Location I hereby acknowledge receipt of the above described materials. Name of Authorized Agent (Print) Signature Receipt Date Please provide two originals 1-Solid Waste Department; 1-Transporter. NAME SHIPPING ADDRESS PHONE PHONE COMPANY NAME DRIVER ADDRESS TRUCK I hereby acknowledge that the above-described materials were received from the generator site and were transported without incident to the destination listed below. DRIVER SIGNATURE SHIPMENT DATE DRIVER SIGNATURE DELIVERY DATE I hereby acknowledge receipt of the above described materials for the generator site listed above