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NON-HA7ARDOUS 22F ,14 .1 1 3 8 0 5 5 6 <br />WAST_ MANIFEST w..?.,.?.•w•?. <br />ri] T iti 1 Idsa 1i1 ?:? 1 [i i pe ! ne, viui ci ty 1. Generator's Name and Complete Project Address <br />` t ?Tr _.. ?. _ 7 ?[ !:'':•I1': ?•:,? t'ii?ai:f LJt;rj;nC:I1 L ? s,;IJ :-a+)`is;;;) 2. Bill to: ?L•i;etY i fL '? 1;:72' ? l Ilb <br />Ia. Generator's Phone ?'? • 7r= <br />3Ei 3 ? cr. - 2a. Account # <br />} 3. Transporter: Complete Company Name and Address 3a. Trensporter s Phone <br />r 4. Transporter: Complete Company Name and Address da. Transporter's Phone <br />?t.IL d 1 U 11141";e Lai {.J, 1 ' 1 5. Designated Management Facility Name and Site Address 5a. Facility's Phone <br />i 103) 02' 8 <br />r: r <br />6. Waste Code/Profile # Waste Description <br />G <br />E <br />N <br />E <br />R <br />T NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br />A <br />O <br />R Waste Cod /Profile # Waste Description <br />Nonfriable Asbestos <br />Quantity <br />Quantity <br />Units <br />Yards or Drums <br />7. Regulatory Agency: Emergency Notification: CHEMTREC (800) 424-9300 <br />Colorado Department of Public Health and Environment y24 hr. toll free phone number <br />4300 Cherry Creek Drive South <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 classed, described, packaged, marked and labeled and Is in proper <br />condition for transportation according to applicable international and govemmental regulations. <br />Ba. Contractor/Generator n <br />Month Day Year <br /> <br />T PrtntedfTy •ed Full Name <br />? gnature IF 11 N me), <br />,r -__ <br />L <br />;'. <br />R <br />- <br />L • VA ?, E t ?• <br />n', <br />A <br />A <br />N _. <br />9. Transporter 1 Acknowledgement of Receipt of Materials <br />P Printed/Typed Full Name <br />_ .. I - Sill gnetixe (Full Name) I <br />r. „ " Month Day <br />?? ?ti Year <br />•+F, <br />R ,.L ?• •? f ;1?? <br />T 10. Transporter 2 Acknowledgement of Receipt of Materials <br />E <br />R <br />Printed/Typed Full Name <br />Signature (Full Name) <br />Month Day <br />Year <br /> 12. Ticket # <br /> 11. Discrepancy Indication Space <br />IF <br />A Initials of Person noting discrepancy Date <br />CI 13. Management Methoda.ocation ? Solidification ? Monofill IX Landfill ? Bio-Beds <br />L <br />I Grid Location (it applicable): <br />T 11. <br />Facility Owner or Operator: Certilication of receipt of waste materials covered by this manifest except as note in item <br />14 <br />y . <br /> - --^--j <br />PrintedfT•yped Full Name, Signature (Full N me) Month Day Year <br /> <br /> <br /> CONTRACTOR'S COPY€ <br />Revision 04115/02