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?I <br /> - _ <br />= <br />INN <br /> 0-1 " I <br />. - M I . <br />. <br /> NON-HAZARDOUS 2;15 , 09 ? (? <br /> WASTE MANIFEST w.. ............... <br /> ?- •!,: - r, - : 1. Generator's Name and Complete Project Address <br /> ?0 $'? ti4 2. Bill to: j•IL r'l ta?i liic: <br /> 1a. Generator's Phone 2a. Account a <br /> y 3. Transporter: Complete Company Name and Address 3a. Transporter's Phone <br /> <br /> iii .?J:r- ?'? .c iC1'..' .,-•1 ' . e11,'"_ X1..1 <br />/ <br /> 4. Transporter Complete Company Name and Address ransportees Phone <br />4a. T <br /> _ <br /> <br /> C F. i 5. Designated Management Facility Name and Site Address Be, Facility's Phone <br /> r <br /> <br /> 6. Waste Code/Profile # Waste Description Quantity Units <br /> _o n,ea -_,% (,azo 1ne ?;nram anra So //JJ <br />/t' 1rt ?i.9 ..J <br />G ?f <br /> <br />E <br />N <br />E <br />R <br />A <br />T <br />NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br />0 <br />R Waste Code/Profile * Waste Description Quantity Yards or Drums <br /> - <br /> Nonfriable Asbestos <br />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 Certiflcadon: <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 /> Be. Contractor/Generator = <br />T inteday0ed Full Name <br />P <br />r 1 „Signature (Full Name) Month Day Year <br />A t <br />t <br />T i' 1 i-• l r 4 14 <br />N 9. Transporter 1 Acknowledgement of Receipt of Materials <br />S <br />P - t-? Printed) typed Full Name Signature (Full Name) Month Day Year <br />o <br />R f.- <br />?- •, ?- <br />T 10. Transporter 2 Acknowledgement of Receipt of Materials <br />E <br />R Printed/Typed Full Name Signature (Full Name) Month 'Day Year <br /> 11. Discrepancy Indication Space 12. Ticket p " <br />F <br />A Initials of Person noting discrepancy Date <br /> 13. Management Method/Location ? Solidification ? Monofill 0 Landfill ? Sio-Beds <br />L <br />I Grid Location (if applicable): <br />T <br />y <br />14. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted In Item 11. <br /> Printed/Type) FulTame . Signature (Full Name) r. - Month Day Year <br /> <br /> <br /> <br /> CONTRACTOR'S COPY <br />Revision M1 51U2