MSV FHO 1.31.1841ISFM Services. Inc. L +0 LAD TICKET
TICKET NUMBER:
CONTRACT OWNER:
HAULING COMPANY:
DATE:
DEBRIS QUANTITY
TRUCK NO.: CAPACITY:
LOAD ESTIMATE ( %): TONS (SCALED):
TRUCK DRIVER NAME:
DEBRIS CLASSIFICATION
LOCATION
LOAD ORIGIN (STREET NAME):
SECTION /AREA:
BURNABLE
NON - BURNABLE
INSPECTOR
MIXED r r
; �'
OTHER '
LOCATION
LOAD ORIGIN (STREET NAME):
SECTION /AREA:
DUMPSITE:
TIME
INSPECTOR
LOADING
; �'
DUMPING
COMMENTS:
WHITE: SFM COPY YELLOW: OWNER COPY PINK: HAULIER'S COPY GOLD: SFM COPY
YV27�
WASTE MANAGEMENT
'"Y ' ". L is vvdgiC i ueiiverea Lo InIS Taclllty on this date Goes
not contain any regulated hazardous, toxic, radioactive waste or DRIVER: PLEASE SIGN HERE
substances, or other non - allowable wastes. I also agree to remove any
non - allowable wastes I bring to this facility, or pay all costs for proper
removal of such wastes, upon request from this facility ".
4uJN1MFL - -
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41ISFM
Services, Inc,
LOAD
TICKET
TICKET NUMBER:
INSPECTOR
LOADING
CONTRACT OWNER:
DUMPING
HAULING COMPANY:
DATE:
DEBRIS QUANTITY
TRUCK NO.:
CAPACITY:
LOAD ESTIMATE
tic
TONS (SCALED ):
TRUCK DEER NAME: _ J
DEBRIS CLASSIFICATION
LOCATION
LOAD ORIGIN (STREET NAME):
SECTIONIAREA:
DUMPSITE:
TIME
INSPECTOR
LOADING
DUMPING
COMMENTS:
WHITE: SFM COPY YELLOW: OWNER COPY PINK: HAULER'S COPY GOLD: SFM COPY
Wwrn':
WASTE MANAGEMENT
Non at,ch 14i 11 1 .
2700 NW 48th
Pompano Beach, FL., .-?,3071*1'
Ph: (954) 984 ,�000
Name SFWIANISHO REVILLHURM
fll - R
` parr I e
'E
bate 0 1 �, 31 j/ 20 18
P_i-vffieylt Type c edit kccotlrit
Gurltltii-4�,i-
14-5111jil ticket#
Or 1 v e-i -
I fig f icket#
wit e
8 i 1 t i tt y#
�A ate
..4e WaAU t�,, _`ode
C 41k 10
ilaflite�tt 541
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Tir-ket# 1.f0*k'A-'j
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2.13-427 . volk(fle
Wo I ,_110 e-_
t 799" 1b
0 1 1 i ij@ 18 01.25•: Tare 3!5198fa I b
Net 4401K lb
Tons 22.00
L! ji 01-igiirF
1 certify that the waste I delivered to this facility on this date does DRIVER: PLEASE SIGN HERE
not contain any regulated hazardous, toxic, radioactive waste or
substances, or other non-allowable wastes. I also agree to remove any
non-allowable wastes I bring to this facility. or pay all costs for proper
removal of such wastes. upon request from this facility".
405W,1FL � -1.1
41ISFM
strwi« =, Inc.
LOAD TICKET
TICKET NUMBER:
TIME
CONTRACT OWNER:
LOADING
HAULING COMPANY:
DATE:
DEBRIS QUANTITY
TRUCK NO.:
CAPACITY:
LOAD ESTIMATE (%):
_
r+
TONS (SCALED):
TRUCK DRIVER NAME:
DEBRIS CLASSIFICATION
LOCATION
LOAD ORIGIN (STREET NAME):
SECTIONIAREA:
DUMPSITE:
TIME
INSPECTOR
LOADING
ly
I
DUMPING
COMMENTS
WHITE: SPM COPY YELLOW: OWNER COPY PINK: HAULER'S COPY GOLD: SPM COPY
Monar -ch Hill Original
WASTE MANAGEMENT 2700 MW 48th Stir eet Ticket#1 1203560
Porpano Beach, F+_, 307,21
Ph: (95'4) `_°184' 00LA
Culstomet, Name SF11414IAMISHOREVILL_HURR SFh1 SER Carrier SFMI414MISHOREVIL_HLIRR
Ticket Date 01/31/2018 i'ehicre# 180-1810 volume
pzyfent Type Credit mcobtrtt Ca"tainei,
Malwai Ticket# I1'r'iV
Hauling Picket# Check
Rout a mi l 11. it +013072
Stete Waste Code Caen E t ; U
Manifest 5542 Grid
Destination
Aft
Prof i.ie
iaener•atnr
t) IRS 40 le Ua?0i�1�tt..• . • ;':mjUTiF1
In 01/3112018 07:51311
out (61/31 /2318 0 +i:
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R
(3r•4s �
Tare
>N#t
Uri*
744660 1
3 1b
9840 lb
i i,odfrrt LD% tit ;+ 00M fate Fee Anount Or in. i1h
I 4 01Y -RGC DISASTER 100 78.00 Yards MIAMIDAt ;�'
"I certify that the waste I delivered to this facility on this date does
not contain any regulated hazardous, toxic, radioactive waste or DRIVER: PLEASE SIGN HERE
substances, or other non - allowable wastes. I also agree to remove any
non - allowable wastes I bring to this facility, or pay aCl costs for proper
removal of such wastes, upon request from this facility
UbL'V FL
�r
Services, Inc. LOAD T I C K E T
TICKET NUMBER:
CONTRACT OWNER:
HAULING COMPANY:
DATE:
DEBRIS QUANTITY
TRUCK NO.: CAPACITY:
LOAD ESTIMATE M: c7
i
TONS (SCALED):
TRUCK DRIVER NAME:
DEBRIS CLASSIFICATION
BURNABLE
NON - BURNABLE
MIXED
i vinrk V Ir— p
LOCATION
LOAD ORIGIN (STREET NAME):
SECTION /AREA:
DUMPSITE:
TIME
ANSPECTOR
LOADING
DUMPING
COMMENTS
WHITE: SFM CORY YELLOW: OWNER COPY PINK: HAULER'S COPY GOLO: SFM COPY
wwn' Monarch Hill Orita-inal
WASTE MANAGEMENT 2700 NW "48th %_5 t.i` =' •1 Tic'!iet# 120.564
Pompano B8achl I'L. 307
Ph; (954) 984- .>wt,MA
Customer Name SF14M91AMISKWEt11LL.HURR SFM SER Carrier, SFf MIAMISHOREVILHURR
Ticket Date: 01131/2018 Vehicle#f 117 -828 tlolume
Payment 1*ype Credit Account Container
Manvial. Ticket# D]e,iver^
HaO inn, T.i.cket# Check#E
{?o tit e Billing f# L401307
State Waste Carl` !;ear, EPA Its
Manifest 5'543 i r-id
Destination
PO
Genet-at OW
Firrfile t,
f 1 IB i_
In 01/31''2018 07:51:59
Out 01131,2018 01r51':b9
Comments
THANK YOU
' Sir h 0
3` N
C.. a x ..
.t frbo Lind Orosi :4320 lb
34760 1 b
Net 39560 1 b
Toms 19. i!-)
ProdUtt LDN MY UUM kcwte f=ee Amount Origin
1 4901Y—RIBC DISASTER, 100 89.010 Var'r . MIAMIDADE.
I certify that the waste I delivered to this facility on this date does DRIVER: PLEASE SIGN HERE
lot contain any regulated hazardous, toxic, radioactive waste or
substances, or other non- allowable wastes. I also agree to remove any Total. Fees
eon - allowable wastes I bring to this facility, or pay all costs for proper •rotai 'riche'
emoval of such wastes, upon request from this facility ".
105W +FL 5
L�
41ISFM Services, Inc.
LOAD T! C K E T
TICKET NUMBER:
TIME
CONTRACT OWNER:
LOADING
HAULING COMPANY:
- --
DATE:
DEBRIS QUANTITY
TRUCK NO.:
CAPACITY:
LOAD ESTIMATE ( %):
Ir
TONS (SCALED)
TRUCK DRIVER NAME:
DEBRIS CLASSIFICATION
LOCATION
LOAD ORIGIN (STREET NAME):
SECTIONIAREA:
DUMPSITE:
TIME
INSPECTOR
LOADING
- --
DUMPING
COMMENTS:
WHITE: SFM COPY YELLOW: OWNER COPY PINK: HAULER'S COPY GOLD: SFM COPY
WASTE MANAGEMENT:
R
i It -ste rpe d���ur►t Or�i.�rt
' M t R!4 x GAi ►E
I r -rtifv thnr +ham .
of contain any regulated hazardous, toxic, d
toxic, rad oactivewaste or
DRIVER: PLEASE SIGN HERE
ibstances, or other non - allowable wastes. i also agree to remove any
on- allowable wastes I bring to this facility, or pay all costs for proper
?moval of such wastes, upon request from this facility ".
405WMFL
r •
IN
41ISFM
Services, Inc. LOAD TICKET
TICKET NUMBER:
CONTRACT OWNER:
HAULING COMPANY:
DATE:
DEBRIS QUANTITY
TRUCK NO.: CAPACITY:
LOAD ESTIMATE ( % }: TONS (SCALED):
TRUCK DRIVER NAME.
DEBRIS CLASSIFICATION
BURNABLE
NON - BURNABLE
MIXED
\. OTHER
LOCATION
LOAD ORIGIN (STREET NAME):
SECTION /AREA:
DUMPSITE:
TIME
INSPECTOR
LOADING
DUMPING
COMMENTS
WHITE: SFM COPY YELLOW: OWNER COPY PINK: HAULER'S COPY GOLD: SFM COPY
Vwn,
WASTE MANAGEMENT
Monarch Hill
2,11110 NW 4-8th, st-f-eat
pospahO Agaiih, FL,
CQ5tDmr;rz i+laMe 6FMif#MlSHOREVIL.L.11ORk SF14 SLR Uar °r,ier-
Ticket fate 01 i;31 /`0to
Yeh icI e#
Pay►aent Type Credit, Account
(1prrtaI fie r
Marmal Ticket#
)vlvir
lialil iolq 'I icket#
Check##
�ea,�ts�
8i_lirrq #
State Waste Cude
Ue6 -_ EPA Ili
Manifest 554'4
Grid
laas t i nat i oar
pa
Vlrofi111 ll
h :
benerat
1 i ur e
In 01.131/2'018 08t.54-.3'i
Out 0i/31 %2018 06:54:35
Q'oxsents, PLACARD, 554p __
f l-{ANI'% Y tO
SF l�hl3�Ht� I a!h1EJRE11 I LFIt.It' k
r�0-7S1 1lut.1j.0e
Product LIi�
I 4901Y- -RLRt; DISASTER 100
Qty UOM t Rate Fee Aso lint Origin
►� . !1i' MIAMI 1rADF
"I certify that the waste I delivered to this facility on this date does DRIVER: PLEASE SIGN HERE
not contain any regulated hazardous, toxic, radioactive waste or
substances, or other non - allowable wastes. I also agree to remove any s /l
non - allowable wastes I bring to this facility, or pay all costs for proper
removal of such wastes, upon request from this facility ". 'f
40',VV,1FL
Total Fee
Total Yi._kee-
i
+
7e1'3i
In$aund
Sr ij;
8,6400
1b
YID
h :
Net
i +�o4 ti
ltr
Aw
_V1 '% _) 4oft%aA
» x
Product LIi�
I 4901Y- -RLRt; DISASTER 100
Qty UOM t Rate Fee Aso lint Origin
►� . !1i' MIAMI 1rADF
"I certify that the waste I delivered to this facility on this date does DRIVER: PLEASE SIGN HERE
not contain any regulated hazardous, toxic, radioactive waste or
substances, or other non - allowable wastes. I also agree to remove any s /l
non - allowable wastes I bring to this facility, or pay all costs for proper
removal of such wastes, upon request from this facility ". 'f
40',VV,1FL
Total Fee
Total Yi._kee-
i
41ISFM 2--�2
ssr►„as, Inc. 10AD TICKET
TICKET NUMBER: + ? r
CONTRACT OWNER:
HAULING COMPANY:
DATE:
DEBRIS QUANTITY
TRUCK NO.: I CAPACITY:
LOAD ESTIMATE { %): ��_ TONS (SCALED):
TRUCK DRIVER NAME:
DEBRIS CLASSIFICATION
LOCATION
LOAD ORIGIN (STREET NAME):
SECTION /AREA:
DUMPSITE:
TIME
INSPECTOR
LOADING
DUMPING
COMMENTS:
WHITE: SFMF COPY YELLOW: OWNER COPY PINK: HAULER'S COPY GOLD: SFMI COPY
Monarch Hill
WASTE MANAGEMENT Lime NW 48th Strpet
beach, l3�73
Pumpamo *a . F� ^
^�954) 98� 2WN�
original
Tick,-t#
� lHOREVILHDRR
Na�e F�l�MI�HO*EVJLL*URR SFM 6ER C arrier SFWl� V
uluwe
Lu�taGer ,r|e# 2-810
Ticket Date 01131/2018 c""^~.- r
payppot Type Lredxt Account Ur i vul F,
iqla m a l �ic4ot0
/ime
[n 81/�1,-2018 10:04a,43 Uut �1/31/2018
Vk
Commentm `
'
THANA v'UU'
I e ��
'
.�
.�
Qt
Prodmc� L�� y
-----_--_--__----_-'_-�__'-----___-
� 4��}Y-RGC D�SASTER \�0 102.��
/
Gruss
`
^ m o
, 1ure
� o
Lheck#
HaulznV |/cket#
81111119 # WN13@/Ll
Ruwte
bell EPA l�
state Waste Code
GrI .
-
Manifest 5546
'
oe�itioatium
PQ
p/ufi\w \/
Generatnr
/ime
[n 81/�1,-2018 10:04a,43 Uut �1/31/2018
Vk
Commentm `
'
THANA v'UU'
I e ��
'
.�
.�
Qt
Prodmc� L�� y
-----_--_--__----_-'_-�__'-----___-
� 4��}Y-RGC D�SASTER \�0 102.��
/
89660 lb
38960 lb
50700 1b
^ 25.35
Fee Amount origin
' ---'--- MIAmIDADE
'
`
"I certify that the waste 1 aellivere to this facility on this date does DRIVER: PLEASE SIGN
not contain any regulated hazardous, toxic, radioactive waste or
substances or other non-allowable wastes I also agree to remove any
non-allowable wastes I bring to this facility, or pay all costs for proper
removal of such wastes, upon request from this fa6lity".
+v
ERE'
t �
.° `'*7�
�
�
Gruss
`
^ m o
, 1ure
� o
^ Net
Tons
.''
89660 lb
38960 lb
50700 1b
^ 25.35
Fee Amount origin
' ---'--- MIAmIDADE
'
`
"I certify that the waste 1 aellivere to this facility on this date does DRIVER: PLEASE SIGN
not contain any regulated hazardous, toxic, radioactive waste or
substances or other non-allowable wastes I also agree to remove any
non-allowable wastes I bring to this facility, or pay all costs for proper
removal of such wastes, upon request from this fa6lity".
+v
ERE'
t �
.° `'*7�
�
�
41ISFM
Services, Inc. LOAD T I C K E T
TICKET NUMBER:
CONTRACT OWNER:
MAULING COMPANY:
DATE: / l % / 1
DEBRIS (QUANTITY
TRUCK NO.: CAPACITY:
LOAD ESTIMATE ( %): TONS (SCALED):
TRUCK DRIVER NAME:
DEBRIS CLASSIFICATION
BURNABLE
NON- BURNABLE
MIXED
OTHER
LOCATION
LOAD ORIGIN (STREET NAME)
SECTIONIAREA:
DUMPSITE:
TIME
INSPECTOR
LOADING:.
DUMPING
COMMENTS
WHITE: SFIVI COPY YELLOW: OWNER COPY PINK: HALLER'S COPY GOLD: SFM COPY
WASTE MANAGEMENT^ .r
UN NW 48th S t -' E, e t
POMO.RDO Be?fih, H
Ph: '9154+
C!f-,Nomer Nave SFMM1AM1'SH3k01(.L41jPR L,,- 1 DER L;urrier
1 xcket 'Date 01/31/20113
tlehicleO
°=':r.'; inept. l'YPe Credit Pccount .
Man�.t�t"l I '4et#
Ln�Ft3inct -.
Driver
1-1,au1ln Ticket#R
R:.+IFt e
State Waste Code
Manifest 5547
Chock#
X i l ling #
Gen EPA .fib
Grid
4, G?sl ,
MIAMIDADE
�a
?if?nPr'atQYY
Time
U1-! t 011,131/2016 M3/ti-A.
'1
Comments placard 0001 -.342
Hi.t i
001.3072
e a off' A In ound
ort • }3
c
r-1
Cross
dare
Net
Tons
13 , '-I t0 9,
3640 i� ,
55100 A to
27.55
Product.
L.D%
y ?t' 00M Rate Fee
Amount Origin
DISASTER
10,1
4, G?sl ,
MIAMIDADE
"I certify that the waste I delivered to this facility on this date does
not contain any regulated hazardous, toxic, radioactive waste or DRIVER: PLEASE SIGN HERE
substances, or other non - allowable wastes. I also agree to remove any
non - allowable wastes I being to this facility, or pay all costs for proper
removal of such wastes, upon request from this facility ".
405WMFL �+
1/
41ISFM -
Services, Inc. LOAD TICKET
TICKET NUMBER:
CONTRACT OWNER:
HAULING COMPANY:
DATE:
DEBRIS QUANTITY
TRUCK NO.:
CAPACITY:
LOAD ESTIMATE ( %):
TONS (SCALED ):
TRUCK DRIVER NAME:
DEBRIS CLASSIFICATION
BURNABLE
NON- BURNABLE
MIXED
OTHER
LOCATION
LOAD ORIGIN (STREET NAME):
SECTION /AREA:
DUMPSITE:
TIME
INSPECTOR
LOADING
DUMPING
/
COMMENTS:
WHITE: SFM COPY YELLOW: OWNER COPY PINK: HAULER'S COPY GOLD: SFM COPY
wv�n_
WASTE MANAGEMENI'
} ' _ .
2700 NW 48th Stt-ee�
Pompano Beach., F i , 33073'
Pht (954) 984 -egOo
C.ostoaer Marne s'I✓1011F(NISHuREtrlL`.HURP SFil SER Lar -i-Jf. 't N3PAI i4:�SN(7Rc.''�i t.l;ip�p.a
7irket Date 01;;;1 "2018 l)relurne
Pa. 'Werlt I * pe Cr ~edit Hec:ol.tnt coat a I n,_ F-
Manual Ticket# Dr^i4:L�r
Hauling Ticket#k Chet' %t#
P vut(i Bi 1) ; rlg #
State Taste Cade Cie" EpA ii:,
Manifest 5548 Cir ~i'3
n � h.
jrfj U 1.r , c
Prof iIw
t E' r N
'�- rjT 'L!#rd
l�r a3�,'3A: et3i$ 1 ��'xi�,•4
Out 01!31f3018 1i:�„'tAi3 `_ ►' '' a
CORIMentS placat'd 273
THANIi , Ou
F.ivo 5 w
T,ry
Net
Toni
Produ 't
Utj'
Urli -;fite ) EE' Amount
4901Y,-RGC
DISASTER 10(?:
'O F.00
Yar &.
"I certify that the waste I delivered to this facility on this date does
not contain any regulated hazardous, toxic, radioactive waste or DRIVER: PLEASE SIGN HERE
substances, or other non - allowable wastes. I also agree to remove any
non - allowable wastes I bring to this facility, or pay all costs for proper
removal of such wastes, upon request from this facility ".
?4220 f. b
r7. ii
or In
WASTE nNANAGEMERfe Al
Cl'rloi ia'1
2700 NW 48th Street
�. P€�ropan" Bt , ti 3'd73 1 Cj : ;.
eat h, F' ;
Phi (954) 984- F-000
Cvstvver Ma#e !SFf4M1(IM1SHU!REVLL "URR SFM SEE Carr1 =�, :;Fi�MIA#�!1SHt7REVILI�JR�'
Ticket Date oli31I2018 'Vehi.l:4 273-42"l tro1
Payment f�,�pe Credit Accoj,knt upQ Cn�tt•. � 4
Manual Ticket# Drrftrer
Hauling Ticket# Check#
Route Bi l) ing # N130.72
Mate Waste Cade Gene EGA TD
Manifest 5548 Grid
Bestinatitin
PO
Prof ile '_7
Generjtor
time w2
clr>}� o C assts► Cf�i f
Ie! Vil /`�t:>18 11� 3� l."> >4t� Bros
Out �� fs1l� f -8 � r �:.��= z ,,; : _..��i�t
Tare
Net
Comments placara 273 Tan
90eo # It,
35980 1.b
1542ET I b
27. 11
Product Lit% fatty U01M Rat '
___- ___- •-- ______..___ s= mount Ori q n
1 4 1Y -RBC DISASTEP. 1@@ 102.00 Yards
MIAMIDADE
G
i __. _ a"_
_• •••i VVaOLU i uCJIVUFUU [O finis Taciiity On this date does —
iot contain any regulated hazardous, toxic, radioactive waste or DRN�Eji PLEASE SIGN HERE
ubstances, or other non - allowable wastes. I a'iso agree to remove any
on- allowable wastes I bring to this facility, or pay all costs for proper
3movai of such wastes, upon request from this facility".
405w MFL
. —Total Fees
SFM
tsrvicsa, lee.
TICKET NUMBER:
CONTRACT OWNER:
HAULING COMPANY
DATE:
rTRU CK N OAD ESTIMATE UCK DRIVER NAME:
LOAD TICKET
DEBRIS QUANTITY
CAPACITY:
TONS (SCALED):
WHITE: SFM COPY YELLOW: OWNER COPY PINK: HALILER'S COPY GOLD : SFM COPY
DEBRIS CLASSIFICATION
BURNABLE
NON - BURNABLE
MIXED
OTHER
LOCATION
LOAD ORIGIN (STREET NAME):
SECTIONIAREA:
DUMPSITE:
TIME INSPECTOR
LOADING
DUMPING
COMMENTS:
WHITE: SFM COPY YELLOW: OWNER COPY PINK: HALILER'S COPY GOLD : SFM COPY
vv�n
WASTE MANAGEMENT
Monarch Hil).
2700 NW Oath Street-
POMMU beach, FL, 3307:&
Ph: (154) 984-M&A
0"Mmer Name S!"MMIAMISHOPEVILLHopp
Ticket Date 01/31/2018 SFM
SER C'4pVier
"Y"Ont Type Credit occoupt
vehiclet
"U41 Ticket#
Cantaiaer
Hauling Ticket#
Drivep
Route
Check#
Mate Wast, Code
ill. Uxog k
manifest
Gen EPA jjj
Destin8tioo
Gr 0
PO
Profil,.
Genpracul"
Time
In 01/31/20113 12:10:29
out 01/31/2018 12;10:29
TMANI-5 yati!
Product
-
----------- - ---------- - -- - -- --- - - --- - UUM Rate
4901Y-RSC DISASTER 100
certify that the waste ( delivered to to
UriqiNaA
Ticket# 003741
"MIAMISHOREVILHUPR
180-1110 Volume
0010072
MOW Gross
799E0 lb
Tore
34820 a
Net
Tons 45A00 lb
22.
.- ---" —1 uloes -----------
Gw uwr any regulated hazardous, toxic; radioactive izi uaTe wastoe or DRIVER: PLEASE SIGN HERE
)Stances, or other non - allowable wastes. I also agree to remove any
i-allowable wastes f bring to this facility, or pay a1J costs for Proper I/
loval of such wastes, upon request from this facility,,,
4-
Amount Origin
MIAMIDADL
41ISFM
Services. Imc. LOAD TICKET
TICKET NUMBER:
CONTRACT OWNER:
HAULING COMPANY:
DATE:
1
DEBRIS QUANTITY
TRUCK NO.:
CAPACITY:
LOAD ESTIMATE
TONS (SCALED):
TRUCK DRIVER NAME:
DEBRIS CLASSIFICATION
BURNABLE
NON- BURNABLE
MIXED
OTHER
LOCATION
LOAD ORIGIN (STREET NAME):
SECTION /AREA:
DUMPSITE:
TIME
INSPECTOR
LOADING
!
1
J�
r/
DUMPING
COMMENTS:
WHITE: SFM COPY YELLOW: OWNER COPY PINK: HAULER'S COPY GOLD: SFM COPY
WASTE MANAGEMENT
,trtga -0, Mcoarch Hill
r-100 M 48th
f PamPann leach. FL, :_�'073 7icl ctl� ;�0s3�9
Ph; (954) 984 --cj ?std
": '�rner Name ' F-14MIAMIS40REVILL.HURRt SFm sER l:ar,r, er SFf+�,�iAMtS#i(77R 4ii�.Hl1Wf2
i, et Date X11 /:ii, :0F8
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l�is39iri;; �. Tisr.�tti-t
Y OT }t aiit}ti'
! - lathing Ticket#
K<Olc f. r
Check.
-atq Waste_ cod"
Bz11).ilq # 00 13072
I`tslil.l Ci?St
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Oest: inat ton
PO
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01Y311/2018
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s.5tr�siblp_z.
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ri
Tare
i
Net
r
JC 1'20 1 b
a�aaer,r
ice.. :..<<
Ions
THANE';
Aeount
0 it i in
79. 00 lards
M T A
certify that
LU of contain any regulated hazardous, toxic, Tammy
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WASTE MANAGEMENT'S
I this date does
of contain any regulated hazardous, toxic radioactive waste or
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DATE:
DEBRIS QUANTITY
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TIME
INSPECTOR
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HIAMIDADE
"I certify that the waste I delivered to this facility on this date does DRIVER: PLEASE SIGN HERE
not contain any regulated hazardous, toxic, radioactive waste or
substances, or other non - allowable wastes. I also agree to remove any
non- allowable wastes I bring to this facility, or pay all costs for proper
removal of such wastes, upon request from this facility ".
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_____(,r; 90). 010 Yards
HIAMIDADE
"I certify that the waste I delivered to this facility on this date does DRIVER: PLEASE SIGN HERE
not contain any regulated hazardous, toxic, radioactive waste or
substances, or other non - allowable wastes. I also agree to remove any
non- allowable wastes I bring to this facility, or pay all costs for proper
removal of such wastes, upon request from this facility ".
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41ISFM
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TICKET NUMBER:
CONTRACT OWNER: m - (j� „ _ L Am
HAULING COMPANY: y
DATE: 1- �7 ! , + a
DEBRIS QUANTITY
TRUCK NO.: Q o- ! r 50 CAPACITY: / 0 L/' 2
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DEBRIS CLASSIFICATION
BURNABLE
NON - BURNABLE
MIXED
OTHER
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SECTION /AREA:
DUMPSITE:
TIME
INSPECTOR
LOADING
DUMPING
COMMENTS:
WHITE: SFM COPY
YELLOW: OWNER COPY PINK: HAULER'S COPY GOLD: SFM COPY