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1 <br />1 <br />1 <br />1 <br />1 <br /> NON-HAZARDOUS r <br />WASTE MANIFEST ~225,040 <br />wun.+...enu.. <br />3 8 0 5 4 6 <br /> Rocky Mounta i n P i pe 1 i ne Company 1. Generators Name and Complete Project Address <br /> 12100 E. I-25 hronta-ge Road Lorglttont, CO SOS04 2.Billto: Rocky Ht Pipeline <br /> 3N%3 286-6400 1a. Generator's Phone 2a. Account # BPI 96 <br /> - &G EE' i?JL? Fiti' F/??%i1? J ?ansporler: Complete Company Name and Address 3a. Transporters Phone ' <br /> ` <br /> 7 C <br />. C3 I? <br /> 4. Transporter: Complete Company Name and Address 4a. Transporter's Phone <br /> &it f a i o Ridge Landf i 1 1 5. Designated Management Facility Name and Site Address 5a. Facility's Phone <br /> 11655 WM 59 (303)732-0218 <br /> K_enesburg, CO 80643 <br /> 6. Waste Code/Profile # Waste Description Quantity Units <br /> 1007362 Unleaded Gasoline iTtamiante Soil <br /> <br /> <br />G <br />E <br />N <br />E <br /> <br />R <br />A <br />T <br />NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br />0 <br /> <br />R <br />Waste Code/Profile # <br />Waste Description <br />Quantity <br />_T _ <br />Yards or 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 80222-1530 <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`doas 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 intemational and governmental regulations. <br /> 8a. Contractor/Generator <br />T P inted/ry 6d Full Name Signature (Full me Month Day Year <br />q r11e e T <br />N <br />S 9. Transporter 1 Acknowledgement of Receipt of Materials <br />P Printed/Typed Full Name SI attire Fulf Nam , <br />Month Day Year <br /> <br />E 10. Transporter 2 Acknowledgement of Receipt of Materials <br />' <br />R 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 /> <br />r <br />1 `0 <br />1 13. Management Method/Location O Solidification O Monofill 1?3 Landfill 0 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 /> Printe y fl Full Dame ; r7 <br />??/ Signature Full Ne,tPe <br />9I ( ) ------- _-?- Month Day Year 4 <br /> <br /> TRANSPORTE <br />O <br />;,/ <br /> R C <br />P <br />I . <br />P.,;o- MN rim.)