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r ? ? ky 1: <br /> <br />NON-HAZARDOUS <br /> <br />25,:90 p <br /> <br />0542 <br /> WASTE MANIFEST <br />w,un wwu?Me,cr Q <br /> : ; <br /> fv:I}:y `r{rit.L''t i a .i ?7 1? i L,` i I:fl :'oml.aT y 1. Generator's Name and Complete Project Address <br /> 'r'.. ;-25 Fri:m'ige Road .1r nga.0T'1t, Co _,0504 2.81111o: Rocky 14t P1)7E:l ine t <br /> 303 216-!,43 <br />1a. Generators Phon <br />e <br />2 <br />A <br /> ccount # <br />a. <br /> •? :>i.' ; / '=,=:? ? c,i,;? • , -" 3=Transporter: Complete Company Name and Address 3a. Trans orler's Phone <br /> <br /> .y <br />?? ?.?.- . ?^ s; :rfJ ,-.-- . i ?!• ??.%. /!' ,.rii!?r? .1 .,/ i ,/'? ' FG?!'iJ <br />s?'1._5 -'? :'rte :T_ ,!T i ??-' <br />- <br />r <br /> ' 4. Transporter: Complete Com(iany Name and Address 4a. Transporter's Phone <br /> <br /> of lfa i. C, i+! ! 1.ge handt 11 5. Designated Management Facility Name and She Address 5a. Facility's Phone <br /> 11.6`15 (3(33?732-4tcit3 <br /> "eeTtesbar•3, CO 80643 <br /> 6. Waste Code/Profile # Waste Description Quantity Units <br /> <br /> <br />G <br />E <br /> <br />N <br />E <br />A <br />A <br />T <br />NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br /> <br />0 <br />A Waste Code/Profile It Waste Description Quantity Yards or Drums <br /> <br /> <br />Nonfriable Asbestos -7 <br /> 7. Regulatory Agency: <br /> Colorado Department of Public Health and Environment Emergency Notification: CHEMTREC (800) 424-9300 <br /> 4300 Cherry Creek Drive South 24 hr. toll free phone number <br /> Denver, CO 80222-1530 <br /> 8. Contractor/Generator Certification: <br /> 1 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 govemmental regulations. <br /> <br /> Be. Contractor/Generator _ _ <br />T (n? P`inledrfypad Full Name TY 7? Signature Full Na e) } Moth Day Year <br /> i Al -J <br />- <br />?6 .x'10 <br />N 9. Transporter 1 Acknowledgement of Receipt of Materiats <br />S <br />P Printed/Typed Full Name SignatuVFulIN a) nMon <br />h Day Year <br /> t <br />T 10. Transporter 2 Acknowledgement of Receipt of Materials <br />E <br />R I Printed/Typed Full Name Signature (Full Name) Month Day Year <br /> 11. Discrepancy Indication Space 12. Ticket # <br />F <br />A <br />Initials of Person noting discrepancy Date <br />-7 C ?? <br />C <br />I <br />13. Management Method/Location ? Solidification ? Monofill ? Landfill ? Bio-Beds <br />L <br />I <br />T Grid Location (it applicable): <br />Y 14. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in item 11. <br /> <br /> Printed(Typed Full Name Signature (Full Name) Moth Day Year _ <br /> I -A <br /> <br /> TRANSPORTER COPY h + a <br />Hevlsion Lwib/n7