HYDRO27641

• Permit No: C1981010
• IBM Index Class Name: Hydrology
• Doc Date: 6/1/1990
• Doc Name: SITE ASSESSMENT FOR UNDERGROUND STORAGE TANK CLOSURE
• From: TRAPPER MINING INC
• To: CDOH
• Permit Index Doc Type: NPDES
• Media Type: D
• Archive: No

,Y ;r, ,
`~~ t ~ CONSERVATIONSERVI INC. ~, •til ~ ~''~`'A`''<~Y''~'°~'~ 4•
,q. f ITT-:'~,,~•'.'~:' ',: ~,} 1 •~~ ~ A-:]1: i L~'S~<.; :'~<: Y{.:\•,.~7:
OFFICES :. 'i : ~.:" ~ ' FACI4 ... ti ... ',~r. -.;~.rc _- O •.. . r~.V
' . ~ ~ dal ; 1:. ~~ .. - , ~~ -,' ••~{N :..030022 '.:__~~
7• ; S ~-
2090E 104th Ave.' ~'• 41800 E. 88th Ave. ~ . y';-." ": - ~ ~ ~ ~ ~~%~:,~, ~ • ~M~'
Denver, CO 80233 'Bennett, CO 80102 _ ... _ '~ .. ,is: \':Y ~~ _
[phone] .~ .1303) 1-644-4335 ' .. ~ ~ ~ - -~ • _~~; ~' ~ '
Fax: [phone] ~ ~ ~ - ~ ~ -
INDUSTRIALWASTE DISPOSAL MANIFEST
PART I: TO BE COMPLETED BY SHIPPER/GENERATOR
COMPANY NAME ~ ~ ~
=,~,~r- 1 ~1,.I.;ir~ r u
BUSINESS ADDRESS ~', ii 1~' ~ Y ~ ~ l ( F' q I % / r, ~ r, 1 ~
,
ADDRESS OF SHIPMENT ORIGIN ~fl r. / ~ ~ ~ ., -, ~ ~ (', 1 ( J
AUTHORIZED CONTACT P , 1 r` ") t•..; ! r ~ EMERGENCY PHONE ' C "' 1! ' !/ ~." I
'" RECEIVER'S NAME CONSERVATION SERVICES, INC.
BUSINESS ADDRESS 2090 E. 704th Avenue Denver, CO 80233 OFFICE PHONE. [phone]
SITE ADDRESS
.~ a 1•!19 (.
QUANTITY UNITS WASTE DESCRIPTION CSI WASTE CODE NUMBER

r . I //

The meteriala Csacrlbe0 above were Donalpnsd to Ms Cartier nomad BIGNANRE OF
below. I tartly that the foropoirp IS true and eortecl to the Dset of my AUTHORIZED
knowled0e. ~ AGENT %
DATE: H ~ ~r / /I AapVE NAML '~ `~ II II ,
PART II: TO BE COMPLETED BY CARRIER/DRIVER ~ - - '
CARRIER NAME
BUSINESS ADDRESS ~~~ W. 62i1d, Ave• AeTTVeY, ~. HOZS6
PHONE NO. 42~-`~T~
leertifythat the materlBle lnttlepuanDlydeaGribedabovaere rsesNSd BIOHATURE OF / ~!
by me for shipment to the above Oeatlrletlon.
~ ~
~n ~ J i
_ -
- .. IIDENT
7( ...
R
•~,. .. ..• ~~ '
. '" DATE: ' U ~r TYPE OR PRINT.
ABOVE MAME: ~ I
I~ ,"v C .~ • ~ / /
~
PART II{: TO BE COMPLETED BY RECEIVER
RECEVERS NAME CONSERVATION SERVICES, INC. -- ~ ~ ~ ~ ~ ~-
~
PHONE No.
Site - 1-844-4335 Office -280-9338
SRE ADDRESS ~7~ ~)• G2nd• Ave. DeTnTeY, ~. SOUb -
RECEIVER'S COMMENTS ~ ~ ~ ~ - ~-

1 Certtly Met the materlab In tlla puenthy OsaOribad In PeTI I ero ~
• 'agNAIURE OP s. ~ ~ - + -
.
'
•'
~ :
. rsceMeE by me. t ... rt<•' . AUTHORIZID ~ - it :
;~
.
: ~.,.
- _ ~1
~:1.' j: ••3, __ 110ENT X
,
. t ..5
•
`
•
,. i, [ .J,
~ ,
-1
~ 1
- TYPE OR PRINT -
-. OATS
~ ~
~ ABOVE MAYS
' ~ ~ YMrt[•OR101MAA YELLOW-YAAMePORf[R RMx•DIStPOYLFK1l71•r QOID •OEMlMIOR ~ ~ .;. -; ~ .. ":~'~