2007-11-20_REVISION - M1982015 ‎(18)‎

• Permit No: M1982015
• IBM Index Class Name: REVISION
• Doc Date: 11/20/2007
• Doc Name: Appendix 2, Rocky Mountain Pipeline Report ‎(March 2, 2007)‎
• From: E-21 Engineering, Inc.
• To: DRMS
• Type & Sequence: TR3
• Media Type: D
• Archive: No

NON-HAZARDOUS o
WASTE MANIFEST
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1
? C• }: )7r +u?,T td.' t? 2? 1 :'1c; ? i i is CC,mlY.il.,y 1. Generator's Name and Compleld Project Address
z( 71 F. . [--5 T'L;,:t*..;:)r. `oa(!. Lccrtcrzrto ?i Co t'.ii5(1•'t 2. Bill to:
3 ',f ti; ;<_3! 1a. Generator's Phone 2a. Account k ,R `Yt;
aei: CD etd t:ompany Name and Address
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3a. Transporter's Phone
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4. Transporter: Complete Company Name and Address 4a.Transporter's Phone ty

Buffalo f? 2 f t_! Lanrif i i 5. Designated Management Facility Name and Site Address 5a. Facility's Phone
1 r%5 5 MCl; 9 --0', ? 3'; .. (-?;+ a r
Yeenesburg, CO 1-0643

6. Waste Code/Profile 4 Waste Description Quantity Units
10,07362 Unlc-aOled Gasoline Conl,aminnted Soti

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T NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest)
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R Waste Code/Profile # Waste Description Quantity Yards or Drums
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Nonfriable Asbestos 7 _
7. Regulatory Agency:
Colorado Department of Public Health and Environment Emergency Notification: CHEMTREC [phone]
4300 Cherry Creek Drive South 24 hr. toll free phone number t
Denver, CO 80222-1530
8. Contractor/Generator Certification:
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
quantities of PCB's or radioactive materials. This waste has been accurately classified, described, packaged, marked and labeled and is in proper
condition for transportation according to applicable international and governmental regulations.
Be. Contractor/Generator _ ;.-
T Printedrr' ad Full Name + Signature'(Full Name).. .. Month Day Year

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5 9. Transporter 1 Acknowledgement of Receipt of Materials
PO r PrintedrIyped Full Name 1 Signature (Full Name) Month Dary Year
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E 10. Transporter 2 Acknowledgement of Receipt of Materials
R Printed/ryped Full Name Signature (Full Name) Month Day Year
11. Discrepancy Indication Space a
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Initials of Person noting discrepancy Date n
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C 13. Management Method/Location C Solidification ? Monofill ? Landfill ? BIo-Beds
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T Grid Location (if applicable):
Y 14. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in Item 11.
Prinled/Typed Full Nep{e Signature (Full Name) Month Day Year
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CONTRACTOR
S COPY

Revision 04/15/02 i