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NON -HAZARDOUS <br />9 �I <br />WASTE MANIFEST <br />1. Generator's Name and Project Location <br />2. Bill to: <br />1 a. Generator's Phone <br />2a. Account # <br />3. Transporter 1 Company Name <br />3a. Transporter's Phone <br />4. Transporter 2 Company Name <br />4a. Transporter's Phone <br />5. Designated Management Facility Name and Site Address <br />5a. Facility's Phone <br />6. Waste Code/Profile # <br />Waste Description <br />Quantity <br />Units <br />r <br />1 <br />006 <br />J it <br />G <br />E <br />N <br />I <br />C, <br />E <br />/ <br />R <br />A <br />T <br />IF ASBESTOS WASTE (Please check the appropriate box) <br />0 <br />R <br />Waste Code/Profile # <br />Waste Description <br />Quantity <br />Units <br />riable RQ Asbestos Class 9 NA 2212 PG III <br />onfriable Asbestos <br />7. Regulatory Agency: <br />Colorado Department of Public H alth 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 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 tc applicable international and governmental regulations. <br />Printed/Typed N e <br />i f Signature f` Month Day <br />Year <br />T <br />1 <br />f�VIM 4A <br />R <br />9. Transporter 1 Acknowledgement of Receiof Materials <br />A <br />N <br />Printed/Typed Na a <br />-j Signature Month Day <br />Year <br />S <br />P <br />O <br />R <br />10. Transporter 2 Acknowledgement of Recei t of Materials <br />T <br />Printed/Typed Na a <br />Signature Month Day <br />Ye <br />E <br />, <br />R <br />11. Discrepancy Indication Space <br />12. Ticket # <br />F <br />A <br />CrFacility <br />ment Method/Location ❑ Sol <br />dification ❑ Monofill ❑ Landfill ❑ Bio -Beds <br />Iation <br />I <br />(if applicable): <br />T <br />Ywner <br />or Operator: Certification of re <br />eipt of waste materials covered by this manifest except as noted in item 11. <br />d Name Signature Month Day <br />Year <br />CONTRACTOR'S COPY <br />