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<br />.. <br /> NON-HAZARDOUS _or_);~, aaq r r~.y~ <br />{~ ~ <br />'i <br />" <br /> WASTE MANIFEST ~F L. <br />d <br />t.. <br /> f.zPA T: iii7a."~'. )d#i.:3'i: , Plete Project Address <br />t ~ .}.'i 1C . 7. Generator's Name and Com <br />_, .. , <br />! l / ~' :~ ~ ' ~ ~ ~t <br /> ,.. I i ti I ~• _~ fit. .A~' ~`~.~J= ~. •_. 2. BIII IO: 1n7..:+9it'jaII 9fr~5i. <br /> .~?4~:;• ~!'>°~'-%xt~ij 1a. Generator's Phone <br />V ~ f_i ,l, S:i N':; <br /> 2a. Account # <br /> 3. Transporter: Complete Company Name and Address 3a. Transporters Phone <br /> .~ i <br />~ ~ L . • v u <br /> ~..+ 4. Transporter: Complete Company Name and Address 4a. Transporter's Phone <br /> I. m,;Tv d.i; Fa atj; it !i: `-3 f.il Si~'('~=ta I5. )O~skfii"ated Management Facility Name and Site Address 5a. Facility's PFr6ne <br /> S°:'it0 :i6U. L.?;. ~~1)tl (: iUKi Y?.OriC7. ~7t,lIP,7G-,., ~._(~i <br /> <br /> 6. Waste Code/Profile k Waste Description <br />~ Quantity Units <br /> ..ck .aJ./.li ~1\SIj!'l.n},iJ~.' -... .iJ -.. l yt ,~.u.IX d.. <br />. .. <br /> / ~~ :/ f• / ~. . <br />G <br />E <br /> <br />N <br />E <br />Ei <br />A <br />T NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br /> <br />0 <br />R Waste Code/Profile N Waste Description Quantify Yards or Drums <br /> <br /> Nonfriable Asbestos <br /> 7. Heyulalory Ayency: <br /> Colorado Department of Public Health and Environment Emergency NOtifiCatlOn: CHEMTREC (800) 424-9300 <br /> a3oo Cherry Creek Drive South 24 hr. toll free phone number <br /> Denver, CO 80222-1530 <br /> 8. Contractor/Generator Certification: <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 /> quantities of PCB's or radioactive materials. This waste has been accurately classified, described, packaged, marked and labeled and is in proper <br /> condition for transportation according to applicable international and governmental regulations. <br />V Ba. Contractor/Generator <br />7 ~ 1 Prin[edRyped Full Name ; Signature (Full Name)+ `'"-` L' - Month Day Year <br /> <br />R ' __--- <br />~, +~ <br />:, ' <br /> <br />`` ~ ~ _ <br />N 9. Transporterl Acknowledgement'of Receipt of Materials ~j <br />S <br />P Printed/ryped Full Name Signature (Full Name) Month Day Year <br />O ~ ~• I . <br />' <br />~ <br />Ft . I i <br />~ 10. Transporter 2 Acknowledgement of Receipt of Materials <br />E <br />R Printed/Typetl Full Name Signature (Full Name) Month Day Year <br /> 11. Discrepancy Indication Space 12. Ticket n <br />F <br />q Initials of Person noting discrepancy Date <br />~ 13. Management Method/Location ^ Solidifioation ^ Monofill ^ Landfill ^ Bio-Beds <br />L <br />I Grid Location (if applicable): <br />V 14. Facility Owner or Operator. Certification of receipt of waste materials covered by this manifest except as noted in item 77. <br /> Printetl/Typed Full Name Signature (Full Name) Month Day Year <br />Iti ~; !Y <br />_~ 1 -, ~ CONTRACTOR'S.-COPY ~' `'< '- ._ - <br />Revision 04/15/02 <br />