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Front Range Landfill <br />FRONT RANGE LANDFILL <br />PO Box 3220 <br />Erie, CO 80516 <br />Weighed: Tammy N. <br />BILL TO: 11234 <br />PALMETTO MIT NTAL <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 80538 <br />DATE IN: 09/04/2014 TIME IN: 10:06 :36 <br />DATE OUT: 09/04/2014 TIME OUT: 10:06:36 <br />INBOUND TICKET Number: <br />03- 01029792 <br />SCALE 1 GROSS WT. <br />57820 LB <br />MANUAL TARE WT. <br />23880 LB <br />NET WEIGHT <br />33940 LB <br />Sty Description <br />Amount <br />10.00 SW-Yard , <br />140.00 <br />TICKET AMOUNT: <br />140.00 <br />X <br />I /WE THE UNDERSIGNED. CERTIFY THAT THE <br />WASTE DELIVERED FOR DISPOSAL IS <br />NON - HAZARDOUS SOLID WASTE MATERIALS. <br />Manifest Number. 0524 <br />HAZARDOUS WASTE Approval Number. rrN Nc"15:50 <br />MANIFEST Expiration Date: <br />Generator Information (generator to complete) <br />Site Name: <br />ER <br />*� 1 City, State: x <br />zip: '► �`�' <br />a ks <br />same material represented on the Special Waste Application identified by the above Special <br />elivered to the transporter on the shipment date referenced below. <br />�e) Signature of Generator's Authorized Agent Shipment Date <br />' ransporter Information (transporter to complete) <br />a <br />•8 i <br />Important Notice <br />Disposal facility below must be <br />notified in ADVANCE before delivery <br />of waste with SPECIAL HANDLING <br />instructions. <br />Operating Hours: M -F 6am-5 PM, Sat 6am-2pm ? <br />,1 E I herby warrant that the above material was picked up at the generator site <br />PHONE • 303 -67 431 A� listed above and delivered without incident to the destination listed below. <br />• F <br />ar <br />e of Driver (print /type) S' store of Driverr Date <br />Section 3 Destination Information (disposal facility to complete) <br />Front Range Landfill <br />1830 WCR 5 POB 320 Waste Codes Volume Received _ T c t # V` <br />Erie, CO 80516 �' '� ° )I <br />Phone: 303 - 673 -9431 Yards � � Tons -- --other <br />Fax: 303 -673 -9432 Charge To \ �,\ Grid Elevation <br />Landfill Authorized Agent Name (print / type) Signature of Landfill's Authorized Agent hate <br />The material delivered above was received at the landfill. <br />White. Landfill Yellow: Generator Pink: Transporter Gold: Consuhant <br />