2014-09-08_INSPECTION - M1985210

• Permit No: M1985210
• IBM Index Class Name: INSPECTION
• Doc Date: 9/8/2014
• Doc Name: Corrective action documentation
• From: Rocky Road Investments
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

+Disposal Volume Fe-� Yards ❑ Tons Contact Perso Ate
Other F_1 Phone
1 hereby warrant that the above material is the same material represented on the Special Waste Application identified by the above Special
Waste Approval Code and such material was delivered to the transporter on the shipment date referenced below.
Generate Authorized Agent Name (pnnt / type) Signature of Generator's Authorized Agent Shipment Date
Section 2 Transporter In €ormation (transporter to complete)
Transporter
City, State: j: 0 .
Zip: _`��.-"
Important Notice
Disposal facility below must be
notified in ADVANCE before delivery
of waste with SPECIAL HANDLING
instructions.
I herby warrant that the above material was picked up at the generator site
listed above and delisered without incident to the destination listed below.
of Driver Date
Section 3 Destination Information (disposal facility to complete)
Front Range Lancmii A
1830 WCR 5 POS 320 Waste Codes Volume Received Ticket #
Erie, CO 80516 Yards
Tons 2 Other
Phone: 303 - 673 -9431
Fax: [phone] Charge To a P Grid Elevation
Landfill Authorized "Agent Name (print /type) Signature of Landfill's Authorized Agent Date
Q__-) The material delivered above was received at the landfill.
White:` 1 Yellow: Generator Pink: Transporter Gold: Consultant
Manifest Number: -
0522
�• �
NON- HAZARDOUS WASTE
Approval Number
1_ /n �
` As-rE CoNNECI'IONS INC.
a,"a�ArF
MANIFEST
Expiration Date:'
Section 1
Generator Information (generator to complete)
Generator Name:
Site Name:
�� )
Address:
Address:
City, State:
j City, State:
Z " ,�,- !, �
Zip:
E_ Zip:
", 5�- �
+Disposal Volume Fe-� Yards ❑ Tons Contact Perso Ate
Other F_1 Phone
1 hereby warrant that the above material is the same material represented on the Special Waste Application identified by the above Special
Waste Approval Code and such material was delivered to the transporter on the shipment date referenced below.
Generate Authorized Agent Name (pnnt / type) Signature of Generator's Authorized Agent Shipment Date
Section 2 Transporter In €ormation (transporter to complete)
Transporter
City, State: j: 0 .
Zip: _`��.-"
Important Notice
Disposal facility below must be
notified in ADVANCE before delivery
of waste with SPECIAL HANDLING
instructions.
I herby warrant that the above material was picked up at the generator site
listed above and delisered without incident to the destination listed below.
of Driver Date
Section 3 Destination Information (disposal facility to complete)
Front Range Lancmii A
1830 WCR 5 POS 320 Waste Codes Volume Received Ticket #
Erie, CO 80516 Yards
Tons 2 Other
Phone: 303 - 673 -9431
Fax: [phone] Charge To a P Grid Elevation
Landfill Authorized "Agent Name (print /type) Signature of Landfill's Authorized Agent Date
Q__-) The material delivered above was received at the landfill.
White:` 1 Yellow: Generator Pink: Transporter Gold: Consultant