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~A)FI tl ff'~'~~p`yk'9 ~ u~ .~~~a~¢_,'y~~'sge~~.~~~ -. <br />i.~-0'1 t 1~ AIUX'h++.^U. ~. (Li xYS. ~=SW:' <br /> NON HAZARDOUS <br />,,,2 , ~,;t <br />~ ~ r- ,h ~-. <br />~ <br /> ~.MF~ <br />WASTE MANIFEST J <br />~r ~~ ~ Y} <br /> r , , _ ,~q; .11t7, 1. Generators Name and Complete Project Atldress <br /> V <br />2. Bill to: 1. t` °! <br /> ~I'i t:;?, ;• ~ 1a. Generators Pnone L' <br />i t 4 I <br />2a. Account # <br /> I 3. Transporter: Complete Company Name and Address 3a. Transporfer's Phone <br /> ,~,. ~;. <br /> 4. Transporter: Complete Company Name and Address 4a. Tmnsporter's Phone <br /> t_.irl F~%e^l ~ 1'.'u%;ailCKi L' i aj ~•iSu 15. besignaled Management Facility Name and Site Address Sa. Facility's Phone <br /> .i~K,~. ._/U;. ~ v.J;. ._`Ai] 1?L3~„I /~0)jt, _ .. c./•. <br /> :r: `..~.~. <br /> r- <br />G. Waste Code/Profile n Waste Description Quantity Units <br /> <br />± li <br />i ., '4 rU 5,,..e. .. . <br />.'/VS /."= lJl l,/'. "Y~.~ 1. 1111 V, ny\.> r-~11 a .. <br />~ ~ <br /> <br />G <br />E <br /> <br />N <br />y, <br />A <br />T NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br /> <br />0 <br />Ft <br />i Waste Code/Profile # <br /> <br />i Waste Description Quantity Yards or Drums <br />I i <br />I <br />I <br />I <br /> - <br /> Nonfriable Asbestos <br /> 7. Regulatory Ayency: <br /> Colorado Department of Public Health and Environment Emergency Notification: CHEMTREC (800) 424-9300 <br /> 8300 Cherry Creek Drive South 24 hr. toll free phone number <br /> Denver, CO 80222-1530 <br /> } <br />t3 <br />C <br />t <br />t <br />/G <br />t <br />C <br />tifi <br />ti <br /> on <br />rac <br />enera <br />on: <br />. <br />or <br />or <br />er <br />ca <br />I hereby certify that the above described waste is not a hazardous waste as defined by federal, state or local regulations and does not contain regulated <br /> ~tuantities o1 PCB's or radioactive materials. This waste has been accurately classified, described, packaged, marked and labeled and is in proper <br /> ~:ondition for transportation according to applicable international and governmental regulations. <br />j {° fla. Contractor/Generator ,. <br />_~- , _. <br />^ <br />~i /~'Pgrited/Type~l'~~~I Marne ? f7 (/' ,f f` Signature (FuIlName) / <br />~ P' Month Day Year <br />R / <br />;" ..r .:.1 ~ / <br />~ __ <br />PJ O, Transporter 1~Acknowledgamenl of eceipt of Materials l~r•~" ~ - "~ <br />:^ <br />P Printed/Typed Fyll Name Signature {Full Namej „ _ Month Day Year <br /> <br />~ w <br />`'"""" <br />o <br />E 10. Transporter 2 Ackno <br />ledgement of Receipt <br />f Materials <br />~~ <br />n PrintedrTyped Full Name Signature (Full Name) Monrll Day Year <br />~ 11. Discrepancy intlicatlen Space 12. Ticket # <br />1" <br />A <br />Initials of Person noting discrepancy Date <br />' ~' <br />~ I <br />h 13. Management Method/Location <br />^ Solidification O Monofill ^ Landfill ^ Bio-Beds <br />I <br />l <br />I <br />i 1. <br />Grid Location (if applicable): <br />~ <br />y , 14. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest eecept as noted in item 11. <br />L <br />- <br />i Prinledriyped Full Name <br />i <br />Signature (Full Name) Month Day Year <br />m~ -r! e~y <br />~ ~y~~t'y'~,"~' ~"~ CONTRACTOR'S COPY $ ~ .a~~'~` r'a~~y <br />Revision 04/15/02 <br />