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T <br />R <br />A <br />N <br />S <br />P <br />O <br />R <br />T <br />E <br />R <br />F <br />A <br />c <br />I <br />L <br />I <br />T <br />Y <br />NON -HAZARDOUS <br />WASTE MANIFEST 199401 � � � <br />1. Generator's Name and Project Location <br />CONTRACTOR'S COPY <br />2. Bill to: <br />1 a. Generator's Phone 2a. Account # <br />3. Transporter 1 Company Name 3a. Transporter's Phone <br />4. Transporter 2 Company Name 4a. Transporter's Phone <br />5. Designated Management Facility Name and Site Address 5a. Facility's Phone <br />6. Waste Code/Profile If <br />Waste Description Quantity Units <br />1 IF ASBESTOS WASTE <br />i <br />(Please check the appropriate box) <br />Waste Code/Profile # <br />Waste Description <br />Quantity Units <br />Fr able RQ Asbestos Class 9 NA 2212 PG III <br />N nfriable Asbestos <br />7. Regulatory Agency: <br />Colorado Department of Public Hea th <br />and Environment <br />Emergency Notification: CHEMTREC (800) 424-9300 <br />4300 Cherry Creek Drive South <br />24 hr. toll free phone number <br />Denver, CO 80222-1530 <br />8. Contractor/Generator Certification: <br />I hereby certify that the above describedaste <br />is nota hazardous waste as defined by federal, state or local regulations and does not contain regulated <br />!Thi, <br />quantities of PCB's or radioactive material' <br />This waste has been accurately classified, described, packaged, marked and labeled and is in proper <br />condition for transportation according to a plicable international and governmental regulations. <br />- <br />` \ �rij to , ed Nam <br />SI/T � <br />Signature( Month Day Year <br />! <br />rs <br />9. Transporter 1 Acknowledgement of Receipt o Materials <br />Printed/Typed Nam <br />Signature Month Day Year <br />10. Transporter 2 Acknowledgement of Receipt <br />f Materials <br />Printed/Typed Name <br />Signature Month Day Ye <br />11. Discrepancy Indication Space <br />12. Ticket # <br />13. Management Method/Location ❑ Solidi <br />'cation ❑ Monofill ❑ Landfill ❑ Bio -Beds <br />Grid Location (if applicable): <br />14. Facility Owner or Operator: Certification of recei <br />of waste materials covered by this manifest except as noted in item 11. <br />Printed/Typed Name <br />Signature Month Day Year <br />CONTRACTOR'S COPY <br />