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?I <br />?P <br /> 414 <br />"?>r:?t?r <br />t <br />?a1w <br />?? f?'?` <br />??'' <br />' <br />?? <br /> . <br />? <br />ti ,_. <br />k_ <br />_;? <br />; `•?..1 <br /> NON <br />-HAZARDOUS <br />! <br /> WASTE 114A14IFEST ? LAS, 040 3 81 <br />W/1lTE M.[Ib[MEME <br />54 5 <br /> ?',. <br /> Rocky I fs111.11ta l n Pipeline Company 1. Generator's Name and Complete Project Address F <br /> 121M E. 1-25 Frontage Road Longmont, CO 80503 2. Bill to: Rocky E. <br />I.? Pipeline <br />' :i <br /> s Phone <br />303 286-6400 1a. Generator <br />2a. Account It # nr' 13R t 96 <br />± <br /> K n . Y .f L..':a »i1 «^ 3. Transporter: Complete Company Name and Address 3a. Transporter's Phone <br /> :el- -0? X10 ?r) <br /> <br /> 4. transporter: Complete Company Name and Address 4a. Transporter's Phone <br /> Buffalo Ridge Landf 111 5. Designated Management Facility Name and Sate Address 5a. Facility's Phone <br /> 11655 14CR 59 <br />(303) 732--0213 <br />E <br /> Keeriesburg, CO 30643 <br /> 6. Waste Code/Profile # Waste Description Quantity Units <br /> 1007362 Unleaded Gasoline Contamianted Soil <br /> <br />G <br />E <br />N <br />E <br />R <br /> <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 T --ya-Zor Drums <br /> <br /> Nonfriable Asbestos <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 60222-1530 <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 />' <br /> quantities of PCB <br />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 /> 8a. Contractor/Generator <br /> <br /> <br />R Prints d Full Name igna`ure (Full Nar,le) ,l ry Month Day Year <br />L <br />N <br />S 9. Transporter 1 Acknowledgement of Receipt of Materials <br />0 PrintedlTyped,Full Name Signature (Full Name )-Month Day Year <br />17 <br /> <br />E o. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />N Printed/Typed Full Name Signature (Full Name) <br />Month Day Year <br />r <br />11. Discrepancy Indication Space 12. Ticket # <br />F <br />A Initials of Person noting discrepancy Date <br />C <br />I 13. Management Method/Location ? Solidification ? Monofill ? Landfill ? Bio-Beds <br />L <br />I <br />T Grid Location (if applicable); <br />Y 1 4. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in item 11. h <br />r <br /> <br />Prin1ecbrhy76d-R0 ame?l y,, •' ?? <br />?"?r Signature (Full me) - Month Day Year <br />s <br />I J <br />TRANSPORTER COPY <br />Revision 04/15102