HomeMy WebLinkAboutBuilding B Asbestos Disposal ManifestT
DENVER ARAPAHOE DISPOSAL SITE (DA
PO Box 460397
3500 South Gun Club Road
Aurora, CO 80046 -0397
(720) 876 -2620
(303) 690 -8138 Fax
Dear Customer,
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.
® Fhnlyd on )00 %ponn +u r,,Yd dprpr•.
1
0
a
IX
W
Z
W
C7
( NON- HAZARDOUS 1 1. General r ID Number
WASTE MANIFEST
5. Generator's Name and Mailing Address
ve
GerkF
6. Transporter 1 Company Name
7. Transporter 2 Company Name
8. Designated ��,r,�
3800 SOIiM Ilene Cc
Aurora CO 80018
I Phone: Waste Shipping Name and Description
3.
4.
I L�_ I l e9 C~
2. Page 1 of 3. Emergency Response Pg h/hooneo 4. Waste Tracking Number A
t J450�0
Generator's Site Address (if different than mailing address)
E)kic3 ' $
(303)997-517l 5 t �v .Fror4 e_ P-d wo s f
cc
U.S. EPA ID Number
U.S. EPA ID Number
1
U.S. EPA ID Number
(720)878 -2620
10. Containers 11. Total 12. Unit
No. Type Ouanttty Wt.Nol.
NOM
11x/34300 � + GV
13. Special Handling Instructions and Additional Information
Tmmporbr 2 stcldpeels & phone s: 6 15" Y S" L-Q, W Q ( (
14. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately
marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and go
Generator's /Offeror's Printed/Typed Name Signature
ylu�'t
j 15. International SMpments
F 71 El Import to U S
eiiU v rer
l�
des abed above by the proper shipping name, and are classified, packaged,
yfirrillnial regulations.
Z Transporter Signature (for exports only): Export from U.S. of entry/exit:
w 16. Transporter Acknowledgement of Receipt of Materials Date leaving U.S.:
m Transporter 1 Printed/Typed Name Signature
EL
U)
Z Tran r 2 Printed/Typed Name
17. Discrepancy
17a. Discrepancy Indication Space
❑ Quantity ❑ Type ❑ Residue
i'
17b. Alternate Facility (or Generator) Manifest Reference Number:
J
U
LL Facility's Phone:
w 17c. Signature of Alternate Facility (or Gmp.ratnrl
! mom1��53a
...�� LOCOWL
18.,Designated Facility Owner or Operator: Certification of receipt of materials covered by the .a est excep oted in Item 17a
[Prin d/Typed Name Signatur
9 -BLC -0 6 10498 (Rev. 9/11)
❑ Partial Rejection
U.S. EPA ID Number
Month Day Year
mth Day Year
mth Day Year
� Il2/�
❑ Full Rejection
Year
DESIGNATED FACILITY'S COPY