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<br />NON-HAZARDOUS <br />WASTE MANIFEST ^ ~ r.: t • ?- 3V t ` <br />W..i. M1WIYRM,Mr1 . `..? ? R1 Y`. 543 Nf <br />' - 1. Generator's Name and Complete Project Address - <br />,+.•tir !{C..tTii:3-li ^t.'F.'Zi:yr.? f?illltii??t7_J <br />2. Bill to: <br />t.:`. a:.1 L'.. - ?'_i ??r'C:l y .:z??+.' i''_,3{3 L':lavila:!'li. , ,-i i _ •._y?•:;+Q l', - {?'}• ,.Ir 1, l..ti^ a 1 Sif^ <br />vt.: <br />1 a. Generator's Phone •'t <br />;'•t3 ;?"{; ?,. s;vi 2a. Account # x.tft <br />/ T45sBones Complete Company Name and Address 3a. Transporter's Phone <br />i /..? i .._L:'/.. <br />4. Transporter: Complete Company Name and Address 4a. Transporter's Phone r' <br />5. Designated Management Facility Name and Site Address 5a. Facility's Phone xy= <br />IZ-11 51) <br />Kr-lenesbuxg, 0) <br />6. Waste Code/Profile # Waste Description Quantity Units, <br />zr <br />Lla:lead?cl f??t.?.;1 irk C.c>n:.a:nt?n*_e:l ;r?i 1 ?i "G <br />i00. 7,;02 <br />E <br />' N <br />E <br />R <br />A <br />T NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br />o <br />R Waste Code/Profile # Waste Description Quantity Yards or Drums K <br />' Nonfriable Asbestos + <br />7. Regulatory Agency: <br />Colorado Department of Public Health and Environment Emergency Notification: CHEMTREC (800) 424-9300 <br />' 430D Cherry Creek Drive South 24 hr, toll free phone number <br />Denver, CO 80222-1530 a' <br />S. Contractor/Generator Certification: Y <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 f <br />condition for transportation according to applicable international and governmental regulations. <br />' Be. Contractor/Generator <br />T rinted/TyPad Full Name Sig nature(Full Na / <br />1P 1 l ) Month Day Year <br />A fJt t _ . 1 T E, :.I i jh,;?r t?;? % ` i ?. L, ; . <br />N 9. Transporter 1 Acknowledgement of Receipt of Materials <br />s r J <br />printed/Typed Full Name ?- Signature (Full Name) Month Day Year <br />T 10. Transporter 2 Acknowledgement of Receipt of Materials <br />E <br />' R Printedrryped Full Name Signature (Full Name) Month Day Year <br />11. Discrepancy Indication Space 12. Ticket # IVES <br />F <br />A Inilials of Person noting discrepancy Date t I , <br />1 13. Management Methodkocation ? Solidification ? MOnofill <br />Landfill ? Bio-Beds <br />L <br />' 1 Grid Location (if applicable): <br />T <br />Y 14 Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in item 11. (+ <br />Ptinted/Typed Fyll Name: Signature (Full Name) Month Day Year <br />1. <br />CONTRACTOR'S COPY <br />' Revision 04115102