HomeMy WebLinkAboutBuilding A Asbestos Disposal Manifestwwnfi.
WASTE MANAGEMENT
Dear Customer,
DENVER ARAPAHOE DISPOSAL SITE (DAIS
FO Box 460397
3500 South Gun Club Road
Aurora, CO 30046 -0397
(720) 876 -2620
(303)690.8138 Fax
As required by federal regulations, Waste Management of Colorado, Inc. is providing you with the
generator copy of the manifest for friable asbestos disposal at the Denver Arapahoe Disposal
Site(DADS).
If you have any questions, please call us at (720) 876 -2624.
Thank you,
Waste Management
From everyday collection to environmental protection, Think Green: Think Waste Management.
® P need on 100% post consumer recycled paper.
ILI- 11169 CVNI
169 -BLC -0 6 10498 (Rev. 9/11)
DESIGNATED FACILITY'S COPY
NON- HAZARDOUS
1 1. Generator ID Number '
2. Page 1 of
3. Emergency Response Phone
4. Waste Tracking Number
WASTE MANIFEST
1
( 800) 424— 9300
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2 J 041
5„�enerator's Name a Mailing Address
dvard
nera is Site Address (if different than mailing address)
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Generator's Phone: cq I'
(3Q) 97- 5175 a I
6. Transporter i any Name
U.S. EPA ID Number
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7. Transporter 2 Company Name
U.S. EPA ID Number
8. Designated F 'li Name a d Site A ress U.S. EPA ID Number
3600 SOUIh Gun Club Road
Aurora CO 80018
Facility's Phone:
(720)876- 2620
9. Waste Shipping Name and Description
10. Containers
11. Total
12. Unit
No.
Type
Quantity
Wt.Nol.
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NONE
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11434300
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3.
4.
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13 Special Handling Instructions and Additional Information
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14. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare
that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged,
marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and governmental regulations.
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Generator's /Offeror's Printed/Typed Name
Signature Month Day Year
1 International Shipments
❑ Import to U.S.
❑Export from U.S. Port of entry/exit:
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Transporter Signature ( for exports only):
Date leaving U.S.:
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16 Transporter Acknowledgement of Receipt of Materials
Transporter 1 Printed/Typed Name
ignat Month Da Year
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Transporter 2 Prin yped Name
Sig lure Month ofiv
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17. Discrepancy
17a. Discrepancy Indication Space
❑ Quantity
❑Type Residue ❑Partial Rejection ❑ Full Rejection
Manifest Reference Number:
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17b. Alternate Facility (or Generator)
U.S. EPA ID Number
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Facility's Phone:
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F
17c. Signature of Alternate Facility (or Generator )
Month Day Year
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18. Designated Facility Owner or Operator: Certification of rechip
erials co ed by th manifest exc as noted in Item 17a
Printed/Typed me
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� Sign ure / th a Year
169 -BLC -0 6 10498 (Rev. 9/11)
DESIGNATED FACILITY'S COPY