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<br /> <br />NON-HAZARDOUS <br />j '-HASTE MANIFEST l ~....M.x...N.?* <br /> <br /> 1. Generator's Name and Complete Project Address <br /> !. 2. Bill to: _ t <br />I I <br />1 1 a. Generator's Phone 2a. Account a <br /> 3. Transporter: Complete Company Name and Address 3a. Transporter's Phone <br /> 4. Transporter: Complete Company Name and Address 4a. Transporter's Phone <br /> 5. Designated Management Facility Name and Site Address 5a. Facility's Phone <br /> 6. Waste Code/Profile n Waste Description Quantity Units <br /> -- <br />?G <br />E <br />N <br />E <br />R <br />A <br />FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br />NON <br />T - <br />0 <br />R ---7 <br />Waste Cede/Profile tf <br />Waste Description <br />Quantity <br />Yards or Drums <br /> <br /> Nonfriable Asbestos <br /> 7. Regulatory Agency: <br />t <br />d E <br />i <br />Emergency Notification: CHEMTREC (800) 424-9300 <br /> ronmen <br />nv <br />Colorado Department of Public Health an <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 />t ea. Contractor/Generator <br />T P(intedlTyped Full Name Signature (Full Name) Month Day Year <br />R <br />A <br />t; N T rrrarisuorter 1 Acknowledgement of Receipt of Materials ' <br />S <br />P <br />Printedfryped Full Name Signature (Full Name) Month Day Year <br />/ <br />O .7 <br />•i,' <br /> <br />? 10. Transporter 2 Acknowledgement of Receipt of Materials <br />! E <br />R Printedrryped Full Name Signature (Full Name) Month Day Year I <br /> 11. Discrepancy Indication Space 12. Ticket tJ <br />F <br />A <br />Initials of Person noting ciscrepancy Date <br />C J 13. Management MethodlLocation D Solidification O Monofill El Landfill ? Bio-Beds <br />LI <br />I <br />I Grid Location (if applicable): <br />T ; 14 Facility Owner or operator: Certification of receipt of waste materials covered by this manifest except as noted in item 11. <br />s! i <br />4 Prinled/ryped Full Name Signature (Full Name) Month Day Year <br />r? f` <br />?i •r ? i <br />CONTRACTOR'S COPY <br />Revision 04115102 '