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three well site check bldg lch-4022

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.ATERRADYNE ENVIRONMENTAL SERVICES, INC.818 Ann Street Fayetteville, NC 28301919/486-4285 / FAX 919/486-0200NON- HAZARDOUS WASTE MANIFESTTERRADYNE JOB It 930098-01 LOAD #ENVR CONSULTANT : Groundwater Technoloqv *G. S. CONTACT : -Bi 11 Hushes1244 B-Executive Blvd. St 106 PHONE : 804-436-7881Chesapeake, VA 23320GENERATOR: Building <strong>4022</strong> CONTACT :Second Street PHONE : --Camp LeJeune MCB. NCTRANSPORTER : Terradvne Environmental Services CONTACT : Tom Hoen isman818 Ann Street PHONE : 919-486-4285Favetteville, NC 28301DESTINATION : m ENVIRONMENTAL SERVICES CONTACT: JERWWE ENVBON. SERVICESFacility 818 Ann Street PHONE : 919/486-4285Favetteville, NC 28301 919/486-.0200 (FAX)WASTE DESCRIPTION: NON-HAZARDOUS PETROLEUM CONTAMINATED SOIL __ ‘3 ibw-45’WASTE ORIGINATION POINT (COMPLETE ADDRESS): Buildinq <strong>4022</strong>, Second Street, MCBCamp LeJeune, North CarolinaTRUCK #GROSS WEIGHT:TARE WEIGHT:NET WEIGHT:GENERATOR’S CERTIFICATION: I certify the materials described above on this manifest are not subject tofederal regulations for reporting proper disposal of HAZARDOUS WASTE.PRINTED/TYPED NAME, TITLE DATE0 hr-&gm-xITRUCK DRIVER’S SIGNATURE (acknowledgerent of receipt of rateria)):Date :NOTED DISCREPANCIES:INSPECTED & ACCEPTED (except as noted above) BY:WHITI: Terradyne OfficeCAIUI: GeneratorPIIK: TransportCOLDElPO3: Pacllity PccelptTRUCKS MUST HAVE (1) THIS MANIFEST AND (2) WEIGHT TICKETTRUCKERS MUST KNOW TARE WEIGHT

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