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

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WAsm CONIYt..C'riONSINC.
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NON - HAZARDOUS WASTE
MANIFEST
Manifest Number: 0517
Approval Number.;
Expiration Date:"$
Section 1 Generator Information (generator to complete)
Generator Name:
Address: --6 ;-)I tJ (,wj, ',y, P J I I
V
City, State: L uy r ► ,C3
Zip:,a S
Site Name: C -zo 1 sia t, , 9 7, r 1:, � _s � y r-
Address: "-i) ,N6 N u, v 1�
City, State: e . ,,� ►c.. ),�
Zip: r,�
Contact Person:; Contact Person: } ,�
Phone #: 594-S213 Fax:
Phone #: u -52 1 Fax:
Common Name of Waste: Consultant: rA l m e 4 $t, �_ t, v e u
r, kkc .r b Address: �1 g 1'-Q '
Description of Waste: � r -� t' �, F� �.� n�r_�Irv� City, State: be 1- 0
Disposal Volume Yards Tons Contact Person: J 0��
0therF_1
ca
Phone #: �U?� -; d 4 ° Fax: " �-� -501-1
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.
Generator's Authorized Agent Name (print / type) Signature of Generator's Authorized Agent
Shipment Date
Section 2 Transporter Information (transporter to complete)
Transporter Name: ,aAA _ , r. i a
Address:
City, State: _C
Zip:
Important Notice
Disposal facility below must be
notified in ADVANCE before delivery
of waste with SPECIAL HANDLING
instructions.
r I herby warrant that the above material was picked up at the generator site
Phone #: -0 listed above and delivered without incident to the destination listed below.
)A tjr
Name of Dn r (print/ type) Sign of Driver Date
Section 3 Destination Information (disposal facility to complete)
Front Range Landfill
1830 WCR 5 POS 320 Waste Codes Volume Received Ticket #
Erie, CO 80516 Yards Tons Other
Phone: 303 - 673 -5431 Grid Elevation
Fax: 303 - 673 -9432 Charge To
Landfill Authorised Agent Name (print / t)pe) Signature of,Landfill's Authorized Agent Date
The material delivered above was received at the landfill.
White:AAndfill Yellow: Generator Pink. Transporter Gold: Consultant
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