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<br /> NON-HAZARDOUS - <br />3815571 <br /> WASTE MANIFEST <br /> <br /> 1. Generator's Name and Complete Project Address <br />11 )Cky VC.,ulita1%1 PipeI ine C ompatly <br /> <br />00 E. I.. 25 1'LC?1{- Aye F.oac! %-n PiG^t , CO 80504' 2. Bill to: <br />'*ci:? Ift <br />. Pipeline <br /> 1a. Generator's Phone 2a. Account ff 131: <br />? <br /> a <br /> } r'' 3. Transporter: Complete Company Name and Address 3a. Transporter's Phone q <br /> <br /> <br /> 4. Transporter: Complete Company Name and Address 4a. Transporter's Phone 3 <br />.z <br /> Buf.fa to RAi ige i-anriif ? l l 5. Designated Management Facility Name and Site Address Sa. Facility's Phone <br /> .ii555 WiC 59 (3,03)732-0218 <br /> Keei16sat. rg r GO 80643 <br /> <br /> 6. Waste Code/Profile # Waste Description Quantty Units <br /> 1Jnleaded Gasoline Contiuttiant_ed Soil .• <br /> <br />I <br />?G <br />E <br />N <br />E <br />R <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 Yards or Drums <br /> <br /> Nonfriable Asbestos <br /> 7. Regulatory Agency: <br />Colorado Department of Public Health and Environment <br />Emergency Notification: CHEMTREC (80 <br />0) 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 /> uantities of PCB's or radioactive materials. This waste has been accurately classified, described, packaged, marked and labeled and is in proper <br /> q <br />condition for transportation according to applicable international and governmental regulations. <br /> 8a. Contractor/Generator <br />T Prinled(ryped Full Name Signature (Full Nam) <br />. Month Day Year <br />R <br />A 1 <br />? - . <br />N 9. Transporter 1 Acknowledgement of Receipt of Materials i <br />' <br />S <br />P , Printed/Typed Full Name Sign Wie Full Nan1e? Month Day Year <br />R <br />T <br />E 10. Transporter 2 Acknowledgement of Receipt of Materials <br />R Printedfryped Full Name Signature (Full Name) Month Day Year •- <br /> 11. Discrepancy Indication Space 12. Ticket It <br />F J C' .11 e <br />/ <br /> <br />A <br />Initials of Peron noting discrepancy Data ? <br />C <br />13, Management MethodfLocation ? Solidification ? Monofill Landfill ? <br />Bio-Beds <br />I <br />L <br /> I Grid Location (if applicable): <br />T <br />Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in item 11. <br />14 <br />Y . <br /> <br /> Prince yped Full, ame r //r Signature (Full;flame Month Day! Year <br /> <br />CONTRACTOR'S COPY <br />lilbars , i , . r . <br />Revision 04115102