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

Contact Person >' Contact Person:.
t
Phoie #:`� Fax: Pha?e Fax:
Iq
Common Name of Waste: U„ �, , „s �- ,�i w e Consultant: i +V\ M t
A4,1 C -Q� S- ;r -LbS Address: on K' � r
s
Description of Waste ) Lt c— a, , d ay P City, State: _E>---
Zip: P
Disposal Volume Yards F-1 Tons Contact Person:
Other F-1 Phan% : 24X 5V07
I 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.
Generator's Authorized Agent Name (print / type) Signature of Generator's Authorized Agent Shipment Date a
Section 2 Transporter Information (transporter to complete)
Name:
Transporter p
p l )4 �'° od `� �� Important Notice
Address:. _ ,;4 -q%� Disposal facility below must be
notified in ADVANCE before delivery
City, State: of waste with SPECIAL HANDLING
Zip:
instructions.
> I herby warrant that the above material was picked up at the generator site
Phone #: listed above and delivered without incident to the destination listed below.
dame of Driver Tint / type) Si of Drives Date
Section 3 Destination Information (disposal facility to complete)
Front Range Landfill
1830 WCR 5 POB 320 Waste Codes F Volume Received Ticket # Erie, CO 80516 Yards _L_ -- Tons Other
Phone: [phone] Grid Elevation
Fax: [phone]. Charge To ,
Landfill Authorized Agent Name (print / type) Signature of Land 's Authorized Agent Date
The material delivered above was received at the landfill.
White:,,Land Yellow: Generator Transporter Gold: Consultant
Manifest Number.
0523
ZARDOUS WASTE
Approval Number.
- ...�....�,..,..��.
MANIFEST
Expiration Date•
Section 1
Generator Information (generator to complete)
�''�
Generator Name:
° Site Name:
li
Address:L-
Address:
L4 ! A)
City, State:
City, State:
Zip:
Zip:
Contact Person >' Contact Person:.
t
Phoie #:`� Fax: Pha?e Fax:
Iq
Common Name of Waste: U„ �, , „s �- ,�i w e Consultant: i +V\ M t
A4,1 C -Q� S- ;r -LbS Address: on K' � r
s
Description of Waste ) Lt c— a, , d ay P City, State: _E>---
Zip: P
Disposal Volume Yards F-1 Tons Contact Person:
Other F-1 Phan% : 24X 5V07
I 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.
Generator's Authorized Agent Name (print / type) Signature of Generator's Authorized Agent Shipment Date a
Section 2 Transporter Information (transporter to complete)
Name:
Transporter p
p l )4 �'° od `� �� Important Notice
Address:. _ ,;4 -q%� Disposal facility below must be
notified in ADVANCE before delivery
City, State: of waste with SPECIAL HANDLING
Zip:
instructions.
> I herby warrant that the above material was picked up at the generator site
Phone #: listed above and delivered without incident to the destination listed below.
dame of Driver Tint / type) Si of Drives Date
Section 3 Destination Information (disposal facility to complete)
Front Range Landfill
1830 WCR 5 POB 320 Waste Codes F Volume Received Ticket # Erie, CO 80516 Yards _L_ -- Tons Other
Phone: [phone] Grid Elevation
Fax: [phone]. Charge To ,
Landfill Authorized Agent Name (print / type) Signature of Land 's Authorized Agent Date
The material delivered above was received at the landfill.
White:,,Land Yellow: Generator Transporter Gold: Consultant