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Non Hazardous Special Waste Manifest <br /> Waste Connections, Inc. Manifest. N2 1762 <br /> #1 Number- SSL- Ekpiration: 6 - <br /> proii7 Site Name: be+rc Liv <br /> Generator Name: <br /> , '0 - 7 AdcAddressF." --��ox Address: :53 <br /> City, State Zip: <br /> j City, State Zip: AG ,IC' <br /> Site Contact; <br /> Generator Contact: (3 rr4 V� <br /> Phone: 7 Z61- �15 3 3 Phone: <br /> 3 c3 - -7 6. �, 5 Fax: Fax: <br /> Name of Waste, , P ..rock, Bill To: <br /> Description of Waste: -�tA !,I V*1 r C. c Address: <br /> City, State Zip: <br /> Disposal Volume: Yard(s) _ Ton(s) Phone: <br /> Other: Fax: <br /> W le <br /> Q61 represerii on the <br /> 'ffik',,tht the above material is the sameoKthe ab?r'Sp <br /> eR nd such material was delivered to the'ffizin's'porter on the shipment clapz;'r U <br /> X? <br /> 9- -11�Uy <br /> 71 <br /> R KMN045-f"" <br /> Section 2-Transporter Information (Must be filled out by the Transporter) <br /> Transporter Name. Important Notice <br /> Address: Disposal Facility below must be notified in <br /> City, State Zip: ADVANCE before delivery of waste with <br /> Phone: 311, <br /> SPECIAL HANDLING instructions <br /> 1 <br /> Truck#: 'ate <br /> M", <br /> IM <br /> -Driver Date <br /> Section 3-Destination Information (Must be filled out by the Disposal Facility) <br /> 5oUthside Landfill Material Code: Account: Mix with Refuse ❑ <br /> ,5715 Highway 78 West Volume Received: Yard(s) Ton(s) D., Other: <br /> Pueblo,CO 81005 Grid: Elevation: <br /> Phone: (719)948-2900 Safety Precautions: Avoid Skin&Eye Contact El Avoid Breathing Dust ❑ <br /> Fax: (719)566-6012 Comments: Ticket Number: -" <br /> -7 <br /> Landfill Authorized Agent Nam si, <br /> RMW�i M��_(print) AU <br /> White: Landfill Yellow: Generator Pink: Transporter Gold- Consultant <br />