SKMBT_60119012314450Dem-Con Landfill
GATEHOUSE
13020 Dem-Con Drive
Shakopee, MN 55379
Truck
Weighed: Wayne
On Truck.
Depo'si I: Dan
Number-
BILL JO: (12 0
Company Name:
Midwest (,Uil Constructors
iver's Printed Name:
100 S. Fullor Street
Signature:
Shakopee MN 515379
Vehicle ID:
Reference: SHOREWOOD
I ruck #, AEQ I
Transporter I's Address:
Origin: HENNEPIN COUNIY
Telephone:
DATE IN: 09/05/2018 IJHF IN: 1:3:52:29
DA IF 0111 : 09/05/2018 TIME 01-1
I: 14:M,50
INBOUND IK1KFI Number: Q
00221681h
S(;A[F I GR(M WI,
fi2240 1,13
MANUAL I*Aff W]
a3200 LB
NET WEIGHT
3fi040 _B
Qty Description
Amount
1M2 Contaminated Soil-'TO
__ I---------"- - - ---I',--
Truck Name, Number Driver:
Manifest #
Owner"s Name:
Owner's Telephonc:
Gonetator/Contractor Telephone:
MPCA Agency 's Telephone:
520 Lafayette Roacl North (651) 296-6300
St. Paul, IVIN 55155
Dern-Con Landfill Dery -Con's Telephom-,
3601. West 130th Street (952) 445 -5755
Shakopee, MN 55379
6. Total Quantity: J. Special Handling/Additional Info.:
El CY E TON
declare that contents of this consignment arc ftilly and accurately described above by
led and labeled, and are in all respects in proper condition for transport by highway
rnment regulations. I further certify that the contents of this c,:)nsignment do not contain
------------ - -- — - --- --- Date:
T ;ignaw re
F 1 11., F,)jscrepancy1ndication 'Space
A
C
,1� or - I Site Owner cf�, Operator: Certification of materials cove.red by this manifest except as noted in item 11.
L U Waste, Di3 _)sa - "0
I
Signature.' Date:
Yellow Copy -- Generator
Wlh+tr:: Copy -- De,,o--Con Pink Copy - T;ansporte-
aerials)
Truck
T
On Truck.
Number-
R
A
Company Name:
iver's Printed Name:
Signature:
N
S
Transporter I's Address:
Telephone:
P
0
P'
Transporter -1 (Acknowledgement of receipt of materials)
T-
- __ ___ __ ___ - ____ — __ ", - -
Cr )ipany Name, Address & Phone;
-
__ I---------"- - - ---I',--
Truck Name, Number Driver:
-
---
Signature and Date:
E
]___
R
F 1 11., F,)jscrepancy1ndication 'Space
A
C
,1� or - I Site Owner cf�, Operator: Certification of materials cove.red by this manifest except as noted in item 11.
L U Waste, Di3 _)sa - "0
I
Signature.' Date:
Yellow Copy -- Generator
Wlh+tr:: Copy -- De,,o--Con Pink Copy - T;ansporte-