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w <br /> c'1ay 16 11 02: 06p David Scava 612 521 7Z13 p. 2 <br /> ' Manifest# , <br /> �� SKB Rosemount fndustriat Waste .Faci[ity : :: � w� ; -; <br /> env,�tomyfrrr.�c . ...� `, .. f .� <br /> 1.Gencrato�'s US EPA ID No.(if any) 2 Page 1 of page(s) <br /> � w: �' • 1 ! • � C�L`CL���(!�!S I iV <br /> 3.Genefator's Name and Facility Address r Mailing Address 1 <br /> �r�y eT arvi�G - ���r �o�s�i'rsc7�a� <br /> F4"� GcnSfr�vc.�ioJ/� �!,� �'¢��"ys'� ��S.�f'� <br /> 4.Generator's Phone �1�Q O �i" L � �/7t� �7N F� �[ I�/ �, <br /> 5.Transparter 1 Comparry Name <br /> t� S'DLl1T/ONS Phone: /,� ;f o?� -�a/3 <br /> 6.Transporter 2 Company Name <br /> Phone: • <br /> 7.Designated Fadtiry Name and S(te Addre� SKB Rosemount Industrial Waste Facility <br /> 13425 Courthouse Blvd. <br /> Rosemount,MN 55068 651-438-1500 <br /> 8A. A temen enerator ontraclor SB. Responsible Agency MPCA <br /> Address .% `+Q� /�p�/tqrj ry i Address 520 LAFAYElTE ROAD NORTH <br /> G City,State,Zip �, j'f�//� City,State,Zip ST.PAUL,MN 55155 <br /> E <br /> N Opel'ator'S PhORe . fr� rf'a.�Z,'�/.� 651-296-7997 <br /> R 8C. U.S DOT Description(including Prnper Shipping Namc) <br /> 9. Contafners 10. 11. i2 <br /> A Totat Unit Waste Profile <br /> o � ��S No. Type Quantity WUVoI Sheet# <br /> R a. <br /> ASBESTOS,9,NA 2212.111 �� ��j j� Q /`���� <br /> � r� ! <br /> b. <br /> 13. Addttional Descdptions 1or Materials t.isted Above pndkatewasee stream App�wal�belav) 14. Special Handl4ng Procedures tot Wastes ListedAbove <br /> a Mf <br /> b.MI �� 'Qd'fe a' l�� <br /> /1��� <br /> 15:Special Handling Instructions and Add'+tional Information EMERGENCY CONTAC7: SKB Use Onty <br /> . /r��� Lnad 8 <br /> Scale VVt. <br /> Tons/Yds. <br /> 16.GENERATOR/ABATEMENT CONTRACTOR'S CERTIFlCATION: I hereby declare that the c�ntents of this consignment are tutly and accurately <br /> described above by proper shipping name and are dassified,paciced,marked,and fabeled,and are in a11 respe�ts in proper condition for transport <br /> by highway aocording to applicable iMemationai and national govemment regulations. <br /> Prinied/Typed Name�i/, G v� Signatur ' ��_ jylonth pay Year <br /> Y 11 l <br /> T t7.Transporter i Acknowledged oi Receipt ot Materials <br /> R <br /> A Printed/lyped Name Signatur ' Mon Day � Year <br /> P � v�� Sc�v� �p- d r r <br /> 0 18.Transpdrted 2 AcknowiedgemeM of Reoeipt of Materials <br /> R <br /> E PrEntedlTyped Name Signature •Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F � � <br /> A <br /> C <br /> L ' <br /> I <br /> T 20.Facility Owner or Operator: CeRificaUon of receipt of no -hazardous materials cover d y this Manifest except as noted in kem 19. <br /> Y <br /> Printedliyped Name Signature a � <br /> White-Reh�m to Ge erat r Green-Facility Copy <br /> Canary-Transporter#2 Pink Transport r#1 Goldenrod-Generator Capy <br />