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TRANSIT MIX AGGREGATES <br />On , 20_, Transit Mix received inert material from <br />Date Year Street Address <br />Colorado Springs, CO. This residence was constructed by <br />Builder's Name <br />No hazardous materials were used by this builder in the construction of the foundation, curbs or gutters <br />on the property. The inert material contains no significant concentrations of ash, rubble or trash from <br />the site, and has no evidence of hydrocarbon contamination. There may be a small quantity of earthen <br />material associated with the inert material. <br />Mac Shafer <br />Vice President Aggregates <br />Transit Mix Aggregates <br />Date <br />