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Mobile Waste Hauler <br />Manifest <br /> <br />Company Name ~____ <br />Vehicle I.~eftse No, ~ <br /> <br />A s~pamte manifest lh~ust be filled out for each wasle load. <br /> <br />39143 <br /> <br />Public Works <br />Waslewat~r Division <br /> <br />City or Eugene <br />410 River Avenue <br />Eugene, Oregon g7404 <br />(54 ! ) 6e2.86o0 <br /> <br /> // <br /> TNE, M/&~TE$ LISTED ABOVE ARE ONLY OF DOMESTIC AND HOUSEHOLD ORIGIN. <br /> I certify that the inf~:tx~/ed libra is tee. complete, and accurate. I am aware of the conditions and requirements of the Mobite <br /> Waste Hauler ~mlt. I u~de~ thai failure to comply wilh lhe permit may result in immediate suspension or the permit and/or <br />. possi~e penall~~~Ai ~ ailed~/ ~ I/bY law. . <br /> <br />~0[~ $ ~OI~YZIt;VSHS 69St£9;Tt~T ~'V.~ 6~:ZT O00Z/CZ/?o <br /> <br /> <br />