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/ L�7 "t.��4J(/j <br /> Non Hazardous Special Waste Manifest <br /> j Waste Connections, Inc. Manifest: N2 VU <br /> Section <br /> Approval Number: SSL- - ) `� Expiration: t G U <br /> Generator Name: C_ �,l�;� r, r Sl�� v Site Name: ` ,- - <br /> Address: Address: `j `7 C. .I <br /> City, State Zip: :C4 trn, �� ' ` �,� City, State Zip: A J, f r S 0 J` lJ <br /> Generator Contact: r � = „��� Site Contact: . <br /> Phone: 0 Phone: <br /> Fax: 9--;11 Ca 3 Fax: <br /> Name of Waste Bill To: <br /> Description of Waste: 4-r•--z r UCH�C _ Address: <br /> City, State Zip: <br /> Disposal Volume: Yard(s) Ton(s) Phone: <br /> Other: Fax: <br /> S2 4 .. <br /> olereby warrant that the above material is the same rnaterial'represented on the Special Waste Application identified by the above,Specia),Waste <br /> q'�proYalcCode and such material was delivered to the transporter on the shipment date referenced below. <br /> r � tiJorzed Agentame'(pririt7 .' rSignature of GeneratoiA�uthordAg " Ship nt Dat <br /> Section 2—Transporter Information (Must be filled out by the Transporter) 0 <br /> Transporter Name: /�� "� Important Notice <br /> Address: 3 5� 3� Sj A Disposal Facility below must be notified in <br /> 1 <br /> City, State Zip: m 1` )��� L2 ADVANCE before delivery of waste with <br /> Phone: -) /i - (3 /,z SPECIAL HANDLING instructions <br /> Truck.#: 3�. -r - <br /> s x sus s r.> <br /> by4Warrantlthak�the above rnatenal was pI& up at the generatorsife listed above'aand delivered without incident to'tlie destination listed <br /> r•-,F -t ;Z-..t•-F. rr chx b ' 9s=itb r- - rtt.€r :-. _ '� _ .. * raa' <br /> ,�tgnatu„rexof£Dr3ver..,, 94e , orb "Miv�. ... <br /> Sectionr • • Disposal <br /> S` thside Landfill• Material Code: Account: Mix with Refuse ❑ <br /> 5715 Highway 78 West Volume Received: Yard(s) Ton(s) T � cd e� Other: _ <br /> r Pueblo,CO 81005 Grid: Elevation: <br /> Phone: (719)948-2900 Safety Precautions: Avoid Skin&Eye Contact ❑ Avoid Breathing Dust <br /> Fax: (719)566-6012 Comments: Ticket Number: <br /> a)4 <br /> Date Landfill Authorized A ent Narita` lint Si Qnatrire of Landfill' Authorized Agent <br /> White: Landfill Yellow: Generator Pink: Transporter Gold: Consultant <br />