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NON-HAZARDOUS :'1?, 380552 <br /> WASTE MANIFEST w.,...,..,.?... <br /> Ro,;kv i io.inta 1 : i P i pe i , ne Company 1 • Generator's Name and Complete Project Address <br /> I -ZC rr.,.?iita.cle Road Lciagaoiit , CO 80504 2.Biuto: Rccky fit Pipeline <br /> 3093 286 .6400 la. Generator's Phone 2a Account # bR 96 <br /> 3. Transporter: Complete Company Name and Address 3a. Transporter's Phone <br /> <br /> <br /> / 4, Transporter: Complete Company Name and Address 4a. Transporter's Phone <br /> Buf A-a t o Ridge Landfill 5. Designated Management Facility Name and Site Address 5a. Facility's Phone <br /> 11655 %1KR 59 (303)7 32 -0213 <br /> Ke:erleGburg, CO 8*64:3 <br /> 6. Waste Code/Profile # Waste Description Quantity Units <br /> -Unleaded Gasoline ontamian 5o l! <br />J 1: <br />,4 <br /> <br />G <br />E <br />N <br />E <br />R <br />A <br />NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br />T <br />O <br />R <br />Waste Code/Profile If <br />Waste Description <br />Quantity <br />Yards or Drums <br /> <br /> Nonfriable Asbestos <br /> 7. Regulatory Agency: <br />Colorado Department of Public Healt4 and Environment <br />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 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 intemational and governmental regulations. <br /> Be. Contractor/Generator <br />T Print!' yped Full Name t-Signature Fu11 Nang) j Month Day Year <br /> I <br />N 9. Transporter 1 Acknowledgement of Receipt of Materials <br />S <br />P <br />P niedrr ed Full Name <br />Signs 138 Month Day Year <br /> <br />T <br />E <br />ib. Transporter 2 Acknowledgement of Receipt of Materials ! <br />R PrintedfTyped Full Name <br /> <br />Signature (Full Name) Month Day Year <br />T <br /> 11. Discrepancy Indication Space 12. Ticket # <br />F 7 G) {? <br />A Initials of Person noting discrepancy Date <br />C 13. Management Method/Location ? Solidification ? Monofill Lf Landfill ? Bio-Beds <br />L <br />I Grid Location (it applicable): <br />T <br />14. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in Rem 11. I` <br />y k <br /> i <br /> PrintedlTyped Full Name ^. Signature (Full Na/ne) Month Day Year <br /> <br /> <br /> TRANSPORTER COPY <br />l