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m <br />Front Range Landfill <br />FRONT RAMOE LANDFILL <br />pC Box 320 <br />Erie, CO 8b516 <br />Weighed- JO C <br />`BILL T0: 11234 <br />PALMETTO ENVIROW NTAL <br />. 4995 YORK <br />ST <br />DENVER CO 50216 <br />4ZARDOUS WASTE <br />Vehicle ID: FRL -14 -055 <br />Reference FRL-WK1 <br />Grid: COLORADO FLAGSTONE <br />NOTES:. 4301 N COUNTY RD 27 <br />po#:; 'LOVELAND, CO 86538 <br />PO#:: <br />09/03/2014 TIME IN: 16:17:29 <br />DATE IN: 09/03/2014 TIME OUT 16:17 :L9 <br />DATE OUT: 0 <br />ifvBUUND TICKET Number: <br />MANUAL GROSS WT- <br />TARE WT. <br />NET WEIGHT <br />C <br />Oty Description <br />10.00 SW-Yard <br />TICKET AMOUNT: <br />x <br />03- 0102959 <br />60940 LB <br />23440 LB <br />37500 LB <br />Amount <br />140.00 <br />140.00 <br />I/y THE UNDERSIGNED 'CERTIFY THAT THE <br />WASTE DELIVERED FOR DISPOSAL IS <br />- m&7 ARDOUS SOLID WASTE MATERIALS- <br />operating "ours. <br />e94 —t <br />M -F Um-5 N. <br />MANIFEST <br />Manifest Number: <br />Approval Number. <br />Expiration Date: <br />0521 <br />�4 <br />Generator Information (generator to complete) --A <br />Site Name: <br />Address: O '�Ci f� - <br />City, State: <br />Zip: C\,-77 <br />l Contact Person: �. <br />Ph €: Fax: <br />c-° <br />r Consultant: E1-:11 r, <br />Address: <br />City, State: <br />��--- zip: <br />a a <br />Tons Contact Person: <br />� P �` <br />represented on the Special Waste Application identified by the above Special <br />transporter on the shipment date referenced below. <br />Ware of Generator's Authorized Agent Shipment Date <br />Information (transporter to complete) <br />Important Notice <br />Disposal facility below must be <br />notified in ADVANCE before delivery <br />of waste with SPECIAL HANDLING <br />instructions. <br />I herby warrant that the above material was picked up at the generator site <br />listed above and delivered without incident to the destination listed below. <br />Sat Dam- i - / <br />pe I <br />Sign of Driver Date <br />Front Range Landfill <br />1830 WCR 6 POB 320 Waste Codes Volume Received Ticket # 1 <br />Erie 80516 Yards 1, , Tons Other <br />Phone: e: 303. 6673 73 -9431 <br />Fax: 303- 673 -9432 Charge To I Grid Elevation <br />Landfill Authorized Agent Name (print / type) Signature of Landfill's Authorize8 Agent Date <br />;' ?1e material delivered above was received at the landfill. <br />White: Landt ll Yellow: Generator Pink: Transporter"` Gold: Consultant <br />