Laserfiche WebLink
r' <br />.a <br />-A&kl --- !ARDOUS WASTE <br />4� •e. UU ou010 <br />[ weighed: Jo C <br />BILL TO: 11234 <br />PALMETTO ENVIRONMENTAL <br />4995 YORK ST <br />DENVER CO 80216 <br />Vehicle ID: <br />Reference: FRL -14 -055 <br />Grid: FRL -WK1 <br />NOTES;: COLORADO FLAGSTONE <br />YARDS :: 4301 N COUNTY RD 27 <br />PO #:: LOVELAND, CO 60538 <br />DATE IN: 09/02/2014 TIME IN: <br />14:02:53 <br />DATE OUT: 09/02/2014 TIME OUT: <br />14:02:53 <br />INBOUND TICKET Number: 03- 01028951 <br />SCALE 1 GROSS WT. <br />59900 LB <br />MANUAL TARE WT. <br />23440 LB <br />NET WEIGHT <br />36460 LB <br />©ty Description <br />Amount <br />10.00 SW -Yard <br />140.00 <br />TICKET AMOUNT: <br />140.00 <br />CX <br />I /WE THE UNDERSIGNED, CERTIFY THAT THE <br />WASTE DELIVERED FOR DISPOSAL IS <br />NON - HAZARDOUS SOLID WASTE MATERIALS. <br />MANIFEST <br />Manifest Number: <br />Approval Number. <br />Expiration Date: <br />0520 <br />Generator Information (generator to complete) ' <br />Site Name: -l��.a <br />b� s Address: 76 ; 5 A <br />4� City, State: v c , C t> <br />Zip: � 67 3 ov <br />V ,i <br />Contact Person: f�3 V �� - L Ire I <br />Phone #: - / 2 i Fax: <br />Consultant: <br />Address: <br />City, State: <br />Q < 77 Zip: <br />Tons Contact Person: <br />Phone #: <br />bev'ye'r, Co <br />�� V� �l t i •s f <br />Fax: " 5� -1 ' 5M q <br />aerial represented on the Special Waste Application identified by the above Special <br />to thetransporter'on the shipment date referenced below. <br />,r 1 <br />Signatum,of Generator's Authorized Agent Shipment bate <br />iorter Information (transporter to complete) <br />w� <br />Important Notice <br />Disposal facility below must be <br />notified in ADVANCE before delivery <br />ofwaste with SPECIAL HANDLING <br />instructions. <br />Operating Hours: M-F 6am-5 PM, Sat Gam -2pm _ erby warrant that the above material was picked up at the generator site <br />Me <br />above„and delivered without incident to the destination listed below. <br />PHONE' 303- 673 -9431 <br />erne of Dn (print / type) Sigiib a of Driver Date <br />Section 3 Destination Information (disposal facility to complete) <br />Front Range Landfill <br />1830 WCR 5 POB 320 Waste Codes -� Volume Received Ticket # / a <br />Erie, CO 80516 Yards Tons , Other <br />Phone: 303 -673 -8431 <br />Fax: 303 -673 -8432 Charge To ! Grid Elevation <br />Landfill Authorized Agent Name (print /type) Signature of Landfill's Authorized'Asent Date <br />The material delivered above was received at the landfill. <br />White: Landfill'` Yellow: Generator Pink: Transposer r` Gold: Consultant <br />