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li <br />1 <br />if <br />I: <br />i <br />G'. <br />t; <br />f; <br />/ <br /> <br /> <br />MiN-HAZAFIDOUS W! <br />' <br />4 <br />•.+/aSTL 11AAi,1I=EST r w..,........,... <br />1 .# 1. Generators Name and Complete Project Address <br /> 2. Bill lo: <br />I <br />la. Generator's Phone 2a. Account r <br />1 I 3. Transporter, Complete Company Name and Address 3a. Transporter's Phone <br />l <br /> 4. Transporter: Complete Company Name and Address 42. Transporter's Phone <br />:j 5. Designated Management Facility Name and Site Address 5a, Facility's Phone <br /> <br /> <br />rl <br />6. Waste Code.'Profile It <br />Waste Description <br />Quantity <br />Units <br />? . <br />.i <br />G - <br /> <br />E <br />N <br />? <br />E <br />R <br />A? <br />T NON.-FRIABLE ASBESTOS WASTE ONLY (Friable may not be shipped on this manifest) <br />i <br />0 <br />F' I Waste Ccde/Profile # Waste Description Quantity Yards or Drums <br /> I <br /> Nonfriable Asbestos <br /> i. 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 />E S. Contractor/Generator Certification: <br /> 1 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 />I quantities of PCB's or radioactive materials. This waste has been accurately classified, described, packaged, marked and labeled and is In proper <br /> II condition for transportation according to applicable international and governmental regulations. <br />i <br />y' <br />r Be. Contractor/Generator <br />T t , Printed/Typed Full Name Signature (Full'Name? ; Month Day Year <br /> <br />?+ <br />S 9. Transporter 1 Acknowledgement of Receipt of Materials <br />& P Printed/Typed Full Name Signature (Full flame) ..•.x Month Day Year <br /> <br />T <br />E 10. Transporter 2 acknowledgement of Receipt of Materials <br />R Printedrryped Full Name Signature (Full Name) Month Day Year <br /> 11. Discrepancy Indication Space 12. Ticket ff <br />F <br />A i Initials of Person noting discrepancy Dale <br />13. Management Method'LOCation ? Solidification ? Monofill eLandfill ? Bio-Beds <br />L <br />I Grid Location (if applicable): <br />T <br />i 14. Facilily Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in item 11. <br />I <br />i <br />PrintedlTyped Full-Name Signature (Full Name) Month Day Year <br />t <br />• ... _ _ . - f f <br />Y r j ,, 1. ? . . ? <br /> <br /> <br />CONTRACTOR'S COPY , <br />b <br />?'- , , r 'Zr ,•- t <br />Revision 04115102 l