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<br /> <br />NON-HAZARDOUS Q q, is <br />WASTE MANIFEST <br />i - 1. Generator's Name and Complete Project Address <br /> 2. Bill to: <br />1a. Generators Phone <br />2a. Account ;s <br /> 3.Transporter. Complete Company Name and Address 3a.Transporter's Phone <br /> 4.Transporter: Complete Company Name and Address 4a.Transportees Phone <br /> 5. Designated Management Facility Name and Site Address 5a. Facility's Phone <br /> <br /> 6. Waste Code/Profile # Waste Description Quantity Units <br /> <br />G <br />E <br />N <br />E <br />A <br />A <br />T <br />NON-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br />0 <br />R <br />Waste Cod Profile # <br />Waste Description <br />Quantity <br />Yards or Drums <br /> <br /> Nonfriable Asbestos <br /> 7. Regulatory Agency: <br />Emergency Notification: CHEMTREC (800) 424-9300 <br /> Colorado Department of Public Health and Environment <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, slate or local regulations and does not contain regulated <br /> quantifies 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 IN <br />T Printedffyped Full Name Signature (Full Namea Month Day Year <br /> . <br />A <br />N 9. Transporter 1 Acknowledgement of Receipt of Materials <br />S <br />P <br />Prinl9d/rNped Full Name <br />Signature (Full Name) r ..---_ Month Day Year <br /> <br />R <br /> <br />E 10. Transporter 2 Acknowledgement of Receipt of Materials <br />R Printed/Typed Full Name Signature (Full Name) Month Day Year <br /> 11. Discrepancy Indication Space 12. Ticket t1 <br />F -, <br />A Initials of Person noting discrepancy Date <br />13. Management Method/Location ? Solidification ? Monofill Q Landfill ? Bio-Beds <br />LI <br />I I Grid Location (d applicable): <br />T" <br />11 <br />d i <br />it <br />. <br />n <br />em <br />14 Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as note <br />y j <br />Y <br />I Printed/Typed Full Name Signature (Full Name) : Month Day Year <br /> <br /> <br />CONTRACTOR'S COPY <br />I <br />,l <br />i <br />_? ?- Revision 04115/02 j