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<br /> <br /> NON-HAZARDOUS <br />225,04-0 q <br /> WASTE MANIFEST O <br /> I OC.r: j I ioun t a ! it Pipe I i I iE? Coinj any 1. Generators Name and Complete Project Address <br /> 2100 F. 1-25 F1"on:_- ge )?oacl >on-giAC+ritr CO _805ki4 2.Bitlio: .Oc-)-y I-It Pipeline 04 <br /> ?t.)"? :r;6-6400 1a. Generator's Phone 2a. Accaunl # <br /> 3. Transporter: Complete Company Name and Address <br />i 3a. Transporter's Phone T <br /> <br /> 4. Transportir: Complete Company Name and Address 4a. Transportees Phone <br />? <br /> ' <br />' ' t <br /> t i I J. 5. Designated Management Facility Name and Site Address <br />1!lge 1.,oI dt <br />?UYia ] •: I1 s Phone <br />5a. Facility <br /> f 1Oi)7 73 2-ti 213 <br /> 1{eer.er- Shur 9, CO 3064 <br /> 6. Waste Code/Profile # Waste Description Quantity Units <br /> 1007362 n;ed eft Gaso ne c.t?;ltam Iarited So Il <br /> <br /> <br />G V <br />E <br /> <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 /> <br />0 <br />R Waste Code/Profile # Waste Description Quantity Yards or Drums <br /> <br /> Nontriable 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 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 international and governmental regulations. <br /> 8a. Contractor/Generator <br />T Printed/Typed Full Name \ Signature (Full Name) Month Day Year <br /> <br />N <br />S 9. Transporter 1 Adknowledgement of Receipt of Materials <br />P f rinleclfTyped Full Name ; • ;Signature (Full Nameh Month Day Year <br />O <br />R f' ;' %02 r <br />T 10. Transporter 2 Acknowledgement of Receipt of Materials <br />E <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 /> 13. Management Method/Location 0 Solidification ? Monofill Q Landfill ? Bio-Beds <br />r <br /> <br />L . <br />I Grid Location (if applicable): A <br />T <br />y <br />14. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in item 11. <br /> <br /> <br />Printed/Typed Full Name <br />Signatu <br />e (Full Name) - <br />. <br />Month Day Year .r <br /> ? <br />r <br />CONTRACTOR'S COPY <br />".J <br />Revision 04115/02