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Now <br /> NON-HAZARDOUS WIM <br />= <br />` <br />`? 381573 <br /> WASTE MANIFEST <br />?'"1 <br />i <br /> 1. Generator's Name and Complete Project Address <br /> ',_.-i'.y '!run air, P1;;7l 1)nv C:i:Gti31V1 <br />2. Bill to: <br /> T-:? S Yit. r'' 1,".a 1 i.•.rr„ <br />t ;. ,I Pi!r=1111= <br /> 1a. Generator's Phone LK 2;3i <br />-6 <br />1 <br />4 2a. Account # $[. '?+; <br /> ;, <br />; <br />.4, <br /> ?. ;::.. 3. Transporter: Complete Company Name and Address 3a. Transporter's Phone <br /> <br /> 4. Transporter: Complete Company Name and Address 4a. Transporters Phone <br /> <br />5. Designated Management Facility Name and Site Address <br />Sty > a Q R d• w L;inc, t 1 1 <br />5a. Facility's Phone <br /> _i65r i•fCR 59 <br /> Keeneabury, Cf) 60643 <br /> 6. Waste Code/Profile # Waste Description Quantity Units <br /> 1007362 UnIaaded 3asol l,ia Containt anted Sol i ? ) <br />'6 <br /> r• <br />G <br />E <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 />0 <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 <br />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 ed Full Name <br />Printedrrkp Signature (Full Name) Month Day Year <br />A ? <br />1e <br />-, . _,d• 1/yt 1 '?1 l- : 1 r , n/ It f d <br />N 9. Transporter 1 Acknowledgement of Receipt of Materials r <br />S <br />P <br />Print d Full Name -• <br /> <br />?, ?`c. <br />? Month Da Yea <br />j Sr natyreme) f- y r <br />.. i." <br />L? ?, , 1 : ?' ter,; , <br />c...•? f <br />R ? ,- <br />T <br />E 10. Transporter 2 Acknowledgement of Receipt of Maleriale <br />R Printedrryped Full Name Signature (Full Name) 4Month Day Year <br /> <br /> 11. Discrepancy Indication Space 12. Ticket # <br />F JU?G <br />A Initials of Person noting discrepancy Date S <br />1 13. Management Method/Localion ? Solidification ? Monofill U(Landfill ? Bio-Buds <br />L <br />I Grid Location (if applicable): <br />T <br />Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest except as noted in item 11. <br />14 <br />Y . <br /> Printedlryped Full Name / Signature (Full Name) -?" Month Day Year <br />f` <br />J:-) r. <br />1" 1 G' <br /> I c <br />r <br /> CONTRACTOR'S COPY <br />Revision 04115102