Document Rj91dQkMg5Lak4Oq9K4zJzk9B
M INNESOTA POLLUTION CO N TRO L AGEN CY DIVISION O F SO LID AND HAZARDOUS W ASTE
In case of Em ergency or S p ill, Im m ediately ca ll 3M
For MPCA use only
1935 W EST COUNTY ROM ) 6*2 ROSEVILLE. MN 55113-2785
ATTN: HWIMS
(612) 733-6100
Please cri^'or type. (Form rfesiflned for use on elite (12-pitch) typewriter.)
Instructions on trad ol form.
U N IFO R M H A ZA R D O U S W A STE M A N IFES T
1. Generator's US EPA ID No.
A LD-00402316
M anifest 2. Page 1
jDocum arrt No.
or 2
.141010
In form ation in shaded area mot
rQuird by Fed eral law. M in n e s o ta r o le * re q u ire ite m s H. a n d I.
3.Generator'sName andMailingAddress
(01/090)
A. State Manifest Document Number
3M STATE DOCKS R D .BLDG.17(F.J.BLACKWELL) DCTR m n 0041010
DECATUR, ALA. 3 5 6 0 2
8. State G en erato r'* ID
4. Generator's Phone ( 205 ) 552-6222
5. Transporter 1 C om pany Nam e
6.
3M P R I V A T E C A R R IA G E
h-H-D
7. Transporter 2 Com pany N m *
9 Designated Facility N am e and Site Address
1
10.
______ _____
US EPA ID N um ber
006 1 7308 2
U S EPA ID N um ber
U S EPA ID Number
ALD004023164 C. State Transporter's ID
D. Transporter's Phono E. S late Transporter's ID F. Transporter's Phone
G. State Facility's ID
3M Chemolite Bldg. 47
Hwy 61 and County Road 19
H. Facility's Phone
|M N D 1) 0- 6- 1 7-Z-9-6 ~9: 6 1 2 - 4 5 8 - 2 1 4 1
11. use OT Description /Including Proper Shipping Name, Harare! Class, and ID Number) HM
12.Conta iners
No Type
13. 14.
Total Quantity
WUUVnoitl
a. Hazardous waste liquid,NOS*QRM-E NA9189
X (Cell Product Tars) 50% Fluorine.
2 2 DM 1 4 9 2 1 P
Waste No,
DO 02
h Waste Flammahle Liquid,NOS*Flammable Liq lid
X
UN1993 (Acrylate Ketone).
Solids
in Methyl
Isobut 11
-3 DM
1- D 2- (I P
D001
iC. Non-Regulated Chemicals (FC Alcohol Bottoms) ^50% Fluorine.
7 DM J J 7-(l P
NOMH
d. Waste Poisonous Solid NOS{Diphenyl Metha ie
X 4,4-Diisocynate) Poison B UN2810.
4 DM 4 & (1 P
D003
b.
d.
15. Special Handling Instruction* and Additional Information
PLACARDS REQUIRED:
48602$
IS. GENERATOR'S CERTIFtCATIOM: I haraby daclamthalttw cont*ntaottW*nalgnnn*nlarahj)ly and aceurawly daacnhad a *w by proper rhipping n*ma n d i n ctauKled, packed, markad, and Lahaled, and are In aM r*apacta In propar condition lor Irampor by highway according to applicable Intoma banal and national
goveniTMnt ng ulitloni.
Unlaaa I am a amill ouanllty gamrater who hi a bean trampled by atahita dr regulalton Irom tha duty to mace a waste mlnknlullon card'Lea Bon under Section
3M3(b) olRCR A, I alao carilfy that I have program In piact to reduce the volume and loilelfy Of wait* generated ta the degree I hive determined to be aeemomt-
catty practteebJe and t hava malactad Via method of traitmant lloraoa. or dllpout currently available ta me which mlnlmlrea the present
and future Ihrael to human haetth and the envtronmenL
Date
Printed/Typed Nam e
Signatujrree.-*7
/
s7 / "
Monrn" "ary Year
FRANK J. BLACKWELL
t 1 7 , Transporter 1 A cknow ledgem ent of Receipt ol Materials
P rin ted Typed Nraamii ieb
\ 1t
(1
1^/
/ _____________ _______ _________________________ j_______Pate
Signature
M onth Day Year
_____ | ^ IIS 'j S' ]
11. Transporter 2 A cknow ledgem ent ol Receipt ol M aterials
PrirtediTyped Name
Signature
Month Day Year
19. Discrepancy Indication Space
L _ l -- L. -
20. Facility O w n er or O perator: Certification of receipt ol hazardous m aterials covered by this m anilest eccept as noted in
Item it .
( Date
rrmtodrTyped Nome A , -
Month Oay.
lV )4M P
U \i$X > A riL -
1
M in n eso t* F orm PQ OD371 OHIO 84)
Year
ProducedPursuant totheMay22, 2007 Settlement AgreementandConsent Orderbetween3MandMPCA
Ti*kr n a n v a w w k irn a V7MI
Exhibit 2758.0168
Stats o f Mlnnoaxvta v 3M Co..
2758.0168-0001
C ourt F lo No. 27 CV ID 2MC2
3M M PCA0O014459
on lit |12-ptch) typew riter.}
Form A p p ro v e d O M B No 2 0 0 0 0 4 0 4 Empires 7 -3 1 -8 6
///.tfo u s
Snaation Sheet)
o ra to r's Name
21. Generator's US E P A 10 No,
ALDQ040Z3164
Manifest 22. Page
Document No
41010
2
Information in the shaded
areas is nol required by Federal law.
DCTR 01/090 L . S ta te M a n ife s t D o c u m e n t N u m b e r
3M CO M PAN Y - S T A T E D O C K S R D . BLDG. 1 7 C F .J.B L A C K W E :JJl M N 0 0 4 1 0 1 M . S tate G e n e ra to r's ID
DECATUR, ALA. 35602
24. Transporter
Company Name
3M PRIVATE CARRIAGE
to25. U S ERA N u m b e r
I MND006173082
N. State Transporter's ID O. Transporter's Phone
26. Transporter_____Company Name
27. US EPA ID Number
P. State T ransporter's ID
20. U S DOT D e scrip tio n (In clud in g P roper S h ip p in g N am e, H a ia rd Class, a n d ID N um b e r)
hm !
....
[Q . T ransporter's Phone
29. C o m ainers No. Type
30.
T o ta l Q u a n tity
31.
U nit W Vol
R. Waste No.
a.
NON REGULATED CHEMICALS.
7 Dt 1955 p NONH
b. Hazardous Waste Liquid,NOS*0RM-E NA9189
X DI n 1 .1 -iVichloroethvlenel. 751 Chlorim ,, 1
c. Waste Corrosive Liquid NOS*Corrosive Mat' `rial
X UN1760 (Hydrazine,Hydrazine Hydrochloridi Watprl a nrvrmc ima tel1v 7.0% chi nr irie.
DM
d.
N E
X
R
AI
OR X
Waste Flammable Liquid,Corrosive,NOS*Flaiitniabla.
Liquid UN2924 (Acetone,Methanol 6 Potassium HvdrmHdcT.
y ' ' 13 DM
Waste poisonous liquid NOS (Toluene Diiso :ynat
Poison B 8N2SXBX UN2811,
4 ;J)M
------------------------- - ---------------- V ---------------------------- ----------------------------- ~
t. Waste Flammable Liquids NOS*Flammable __
X Liquid UN1993 (Lab Samples).
8 DM
160 p F002
3480 P D002 D001
7802 p D002
692 p D003
2440 P D001
0- Waste Flammable Liquid NOS*Flammable Liq lid
X UN1993(Inhibited ethyl acrylate).
2 DM
h. Waste Flammable Liquid N0S*Flammable Liq lid 2 X UN1993 (Fluorochemical Solids in Isoprop mol) DM
424 P D001 590 P D001
*
S. A d d itio n a l D escriptions fo r M aterials Listed A bove
T , H a n d lin g Codes fo r Wastes L is te d A b o ve
32. Special H a n d lin g In stru ctio n s and A d d itio n a l In fo rm a tio n
T 3 3, T ra n s p o rte r ___ _ A c k n o w le d g e m e n t o f R e ce ip t o f M a te ria ls
a
A P rinled/Typed Name ,
( Signature
N
S
O 3 4 . T r a n s p o r te r _____A c k n o w le d g e m e n t o f R e ce ip t o f M a te ria ls
T Printed/Typed Name f n
S ig n a tu re
f 35. D iscrepancy Indication Space
A C
L 1 T Y
Form 27193
^
ProducedPursuanttotheMay22, 2007Settlement AgreementandConsent Orderbetween3MandMPCA
2758.0168-0002
'
D ate M o n t * 09Y
In '
7i s s v n
D ate
M o n th Day r w
___ 1 1________ _______
3M MPCAQ0014460