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� I <br /> e I <br />' May 16 11 a2: 06p David Scava 612 S21 7213 p. � <br /> + • Manifest� j� ` <br /> �� ���� SKB Rosemount IndustriallNaste .Faci[ity � ;t, � c�� �,-� I <br /> �1'Y/ROJYIb'Cli7"AL ' S �� �-+ '., i ' <br /> 1.t3cncrata�'s US EPA ID No.{ifany) 2.PBge 1 af pege(8) , <br /> w � ' � ' � ��QL.Y'�����SJiV <br /> 3.Gertiera�er's Name and Faailly addiass ,r Mauing address ` �1 <br /> . E� vT�Yc�nO • '��r ���>sTr��e7��4 <br /> �Ccn,s'fi^vr.�ia S{l�s"613"�6 3'�S•t"� <br /> 4.Generator's 1'hone ' Oj� m ,�� }f /lf� Fax � <br /> 5,Transpattar 1 Compsrry Name ' <br /> 'e ��1.����NS Phone: �.� �a� "jo��.� <br /> 6.Transportor 2 Campany IVame <br /> Phone• • <br /> T.pesignated Faclihy Name and Site Address ���osemount Tndustrial Waste Facility <br /> 13425 Courthouse Blrrd. <br /> Rosemount,MN 55058 651-�438-i500 <br /> . temen enera or on ra or a6. Responsible Agency MPGA <br /> Address �LvQ�/��/��j �1'+ Address b20 I.AFAYET"f'E ROAd NORTtt <br /> cd qty,Staie,rp z , ,�f�l/,� City,SRale,Zlp ST.PAUL,MN 55155 <br /> � . <br /> N OperaWr's Phone I�o^�65�68&�69�0 fi/ �o�vZ'�•�..� � BS1-298-7997 <br /> � enptson �nc a mg mper -pping 1V <br /> R . . . S. Cantefners y0. 77. Y2. <br /> q Totat llnit Wsste ProfllB <br /> T � ��S No. Type Quantlty WWot 8tteet# <br /> 0 <br /> R 8. • <br /> ASBESTOS,9,NA 2212.111 /✓��' � 3 f'?Q j�7 e��p� <br /> i v�+� r rl`i� / ,7/ d <br /> a, , <br /> 19. AddtUonal Descrlptlons 1oc Matertalx tisfed Above pndkat+s wasts etream ApprovW 1�6elow) 14. Spdctal Handling Prooedures tor Wastes Usted Above <br /> a MI i • <br /> b.MI �;J '�3Y)'{�c�' j fJ/►� <br /> 1N�i' <br /> - 1s:Special Han8ling tnstructions and Additional InfarmaUon EMF_l4GENCY CUNTACT: SKB Use Onty <br /> Load# <br /> �►/��/y�� Scale Wt. <br /> , r s i� TonslYds. <br /> 1 B.GENERA'i'4R/ASAY�M�N7 CONTRAGTOR'8 CERT'IFICATION: I hereby deGarQ that the conients of this cons�c�nment ere fully snd accuratety <br /> descrlbed above by proper shipping name and are ctassified,packed,marked,and labeled,and are in ali raspecis!n proper conditlon iar Sransport <br /> by highway according to applicabie intemalional and natlonal govemmeM regulattons. <br /> Printecilfyped Name Stgnatur ' �+lonth pay Year <br /> � / G Yt� r�' �/ l <br /> Y 77.Transporter t Acknowledged of Recetpt of Malerials ' <br /> A Printedrryped Name �/ Signatu ' Mon �ay � �ear <br /> s � J�/17 �'C�YO a�'t�' � d <br /> 0 18.TranspoRed 2 Acknowiedgement of Reaeipt of Materlals • <br /> R <br /> T Prfntsdli'yped Name Signacure •Month Oay Year <br /> E <br /> R <br /> 29.Dlscrepancy tndication Spaae <br /> F � � <br /> A � <br /> C <br /> � <br /> L <br /> t <br /> Y20.Facliity Owner or Operator: Certitication of recaipt of no -hazardaus matedafs cover d y this Manlfest except as noted in Item 19. <br /> Printed/Typed Name Signature a � <br /> White-Retum to Ge erat r Green-�acility Copy <br /> Canary-Transporter�Z Plnk 7ransport �#'1 Goldenrod-Qenerator Copy <br />