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r <br />WAMS CAN] <br />Front Range Landfill <br />FRONT RANGE LANDFILL <br />PO Box 320 <br />CErie, CO 80516 <br />Weighed: Jo C <br />BILL TO: 11234 <br />PALMETTO ENVIRONMENTAL <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: 09/03/2014 TIME IN: 13:55:41 <br />DATE OUT: 09/03/2014 TIME OUT: 13:55:41 <br />Manifest Number. 0519 <br />OUS WASTE Approval Number. <br />TEST Expiration Date: ° 7_° 1Z <br />)r Information (generator to complete) <br />Site Name: t ,; �.,I ca ► , , ;;.>+ <br />Address: P? k 'T7 <br />City, State: zA r I $ 7 <br />Zip: C <` <br />Contact Person: <br />Phone #: a-u j 213 Fax: <br />S.:�s 1 Consultant: RA i V q- .) �f` V B # ,7V'? yA e0 , , <br />=)--- Address: - i q 13 �,e c, i <br />INBOUND TICKET Number: 03- 01029454 <br />� . i City, State: Dv v� ,s el -T- <br />SCALE 1 GROSS WT. 52520 LB Zip: So <br />MANUAL TARE WT. 23440 LB <br />NET WEIGHT 29080 LB yy bo <br />Is Contact Person: <br />©ty Description Amount <br />10.00 SW -Yard 140.00 Phone #: -'' ' S Fax• - m ��� <br />I I TICKET AMOUNT: 14000 lesented on the Special Waste Application identified by the above Special <br />. <br />V( isporter on the shipment date referenced below. T <br />e of Generator's Authorized Agent Shipment Date <br />Cx Information (transporter to complete) <br />I /WE THE UNDERSIGNED, CERTIFY THAT THE <br />WASTE DELIVERED FOR DISPOSAL IS <br />NONHAZARDOUS SOLID WASTE MATERIALS. <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 wan-ant that the above material was picked up at the generator site <br />listed above and delivered without incident to the destination listed below. <br />Operating Hours: M-F 6am -5 PM. Sat 6am -2pm j <br />PHONE: 303-673-9431 <br />ame of Driv (print / type) Signat ure of Driver Date <br />Section 3 Destination Information (disposal facility to complete) <br />Front Range Lanttflll <br />1830 WCR 5 POB 320 Waste Codes Volume Received Ticket # <br />Erie, CO 80616 Yards Tons Other <br />P Fax: 303 -673 -5432 hone: 303 -673 -9431 Grid Elevation <br />Charge To 4 ' <br />Landfill Authorized Agent Name (print / type) Signature of Landfill's Authorized Agent Date <br />The material delivered above was received at the landfill. <br />White: Landfill Yellow: Generator Pink: Transporter Gold: Consultant <br />