Connell Skaggs-LR 940412 Colc~Springs Processing & Disposal Service
Texas Department of Health Permit//1225
1300 Cold Springs Road · Fort Worth, TX 76102 · (817) 332-4939
11027
GENERATOR INFORMATION
A
WASTE REMOVED FROM: __ GREASE TRAP
~..~'R~T TRAP
__ OTHER /
WASTE TANK OR TRAP CAPACITY: ~'~ GALLONS
I CERTIFY THAT THE WASTE MATERIAL REMOVED FROM THE ABOVE PREMISES CONTAINS NO HAZARDOUS
MAIERIALS ~ * ' '~ 'x,
GENERATOR/REPRESENTATIVE NAME: ~'~,.
IRA~SPORI[R I~FORMAIIO~
~ , (MUST BE COMPLIED BY T~NSPORTER)
I CERTIFY THAT THE INFORMATION .PROVIDED ABOVE IS CORRECT, AND THAT ONLY THE WASTE CERTIFIED FOR
REMOVAL BY THE GENERATOR IS CONTAINED IN THE SERVICING VEHICLE. I AM AWARE THAT FALSIFICATION OF
THIS TRIP TICKET MAY/~ULT IN P~)SECUTION.
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DRIVER NAME: ~-..~.~,~/L-.1/CJ~' ~
~A~.A~ TIME ~TE T~NS~RTED) :: : ',
(DRIVER SIGNA'~3J RE)
DISPOSAL INFORMATION
(MUST BE COMPLETED BY DISPOSER)
BUSINESS NAME: Cold Springs Processing
ADDRESS: 1300 Cold Springs Road; Fort Worth, Texas 76102 TELEPHONE: 817-332-4939
TDH REGISTRATION NO: 1225
SPEaF~ED WASTE AN D THAT I HAV~ C~SPOSED OF THE WASTE IN ACCORmNCE W'~~~"-~l~"' -- :'OUTL'N ED
IN THAT AUTHORIZATION. , / / . ~:..~'~ t~. ~ ~
(DATE AN D TIME WASTE ~IVE~) ~ ~P~TOR SIGNATURE)
WHITE - City ~ gREEN - Oi~o~l YELLOW - City FINK - Generator GOLDENROO - Transporter