Laserfiche WebLink
<br /> <br /> 1 <br /> su <br /> NON-HAZARDOUS <br />1 <br />3815611 <br /> 25,040 <br />WASTE MANIFEST r <br />wwm runwan.nr" , <br /> <br />k^ 1. Generator's Name and Complete Project Address <br />??'.c}+ ik<< :t oil? rtpe11rte Company t <br />r <br /> <br />12100 E.. T-25 F'r'ontage road Longmont, C.0 80504 2. Bill to: <br />R^ :ity Mi Pipeline <br /> 1a. Generator's Phone <br />303 286-6400 jty <br />2a. Account tr BR 36 <br /> <br /> '1.. + ;; •._?';; ?l, )=1 rn ' 3. Transporter: Complete Company Name and Address 3a. Transporters Phone 4 <br /> <br />i . <br /> <br /> 4. Transporter: Complete Company Name and Address 4a. Transporter's Phone <br /> <br /> Buffalo F.?ci +ae L 5. Designated Management Facility Name and Site Address <br />ard? i l l 5a. Facility's Phone <br /> 11655 11 t'? c•t1 <br />(303)732-0216 <br /> YCGenesburg, CO 80643 <br /> 6. Waste Code/Profile # Waste Description Quantity Units <br /> 1007362 Unleaded Gasoline Contamianted Soil <br /> <br />G <br />E <br />N <br />E <br /> <br />R <br />A <br />T <br />NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br />O <br /> <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 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 govemmental regulations. <br /> Be. Contractor/Generator <br />T <br />a Printed/T ped Full Name <br />• .? A '? STS , ') <br />A /t1 E ? } -nature (ull Na e) _ Month Day Year <br />yr y ;I <br /> . ? <br />? <br /> 9. Transporter 1 Acknowledgement of Receipt of Materials <br />i <br />S _ <br />P Printed/Typed Full Name l} SI ature uIt. Nai Month D#? Year <br /> <br />T 10. Transporter 2 Acknowledgement of Receipt of Materials <br />E <br />R Prinled(Typed Full Name Signature (Full Name) Month Day Year <br /> 11. Discrepancy Indication Space 12. racket ft <br />F <br />f P <br />I <br />iti <br />l <br />di <br />i <br />%? <br />A n <br />a <br />s o <br />erson not <br />ng <br />screpancy Date - <br />C <br />I <br />13. Management Method/Location p Solidification ? Monofill ? Landfill ? Bio-Beds <br />L <br />I Grid Location (if applicable): <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. F <br /> <br /> Prinled/T ped F Narrte. Signature (Full Name) "- -" Month Day Year <br /> <br /> <br /> TRANSPORTER COPY <br />Revision 11411 RIM