2007-11-20_REVISION - M1982015 ‎(18)‎

• Permit No: M1982015
• IBM Index Class Name: REVISION
• Doc Date: 11/20/2007
• Doc Name: Appendix 2, Rocky Mountain Pipeline Report ‎(March 2, 2007)‎
• From: E-21 Engineering, Inc.
• To: DRMS
• Type & Sequence: TR3
• Media Type: D
• Archive: No

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NON-HAZARDOUS 225 , 040 - 380548-
WASTE MANIFEST w....«.,..•.?.... '
Ro.. ky l fCi -L-a i n Pipeline G=mpan }' 1, Generator's Name and Complete Project Address
,.21;,;, E. I-25 Frontage Road Longmont, GO 80 504 2. Bill to: Oct}Cy !ti Pipe iite
303 20-6_64W 1a Generator's Phone DR 96
Account #
2a
.
3. Transporter: Complete Company Name and Address 3a. Transporter's Phone h'
.
, 4. Transporter: Complete Company Name and Address 4a. Transportees Phone .
.A
1.3

, i)) 5. Designated Management Facility Name and Site Address
?? .1f.
ii' .`. ?t I J ' ! J.j r &

5a. Facility's Phone

K
1:1535 VK'R cct (`.'03171:.-t0:, c

6. Waste Code/Profile If Waste Description Quantity Units
1007362 Unleaded aso.irin Contamianted Soil

G
E
N
E
R
A
T
NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest)
0
R Waste Code/Profile It Waste Description Quanti ty Yards or Drums

Nonfriable Asbestos
7. Regulatory Agency:
Colorado Department of Public Health and Environment
Emergency Notification: CHEMTREC [phone]
4300 Cherry Creek Drive South 24 hr. toll free phone number
Denver, CO 80222-1530
8. Contractor/Generator Certification:
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
quantities of PCB's or radioactive materials. This waste has been accurately classified, described, packaged, marked and labeled and is in proper
condition for transportation according to applicable International and governmental regulations.
Be. Contractor/Generator'.
T l Printe ed Full Name
..
? Signatur6 (Full NarAe) Month Day Year
A t?t.)
??,t1E t, iY` ){
N 9. Transporter 1 Acknowiedgement of Receipt of Materials
'
S
P
0 ?r?aye yped Full Name
lilt'= / -; ?!/ Signature (Full Name Month Day Year
T
E 10. Transporter 2 Acknowledgement of Receipt of Materials
R PrintedlTyped Full Name Signature (Full Name) Month Day Year ,
• • • r
11. Discrepancy Indication Space 12. Ticket #
F
A Initials of Person noting discrepancy Date
C
I
13. Management Method/Location ? Solidification ? Monofill [;Y. Landfill ? Bio-Beds
L
I Grid Location (it applicable):
T
y
14. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in item 11.

PriniedTyped FulLflame/ % Signature (Full Na") .--"- Month Day Year

CONTRACTOR'S COPY q i
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