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. / ,: J•.:.,,r ern t:. ir.• nn . in~ ~ 17 ~pncl,) rynrwrnrr 1 <br />Fvm AlAxnv,•q N.Af! rJu ?f`.r•n 003^. E.pnvr ~ ?^ D) <br />' <br />:)fJIFOxt ~d HAZARDOUS t Gener aloi~5 US EPA ID tJp Manliest Documnnl r.lo <br />2. Paget <br />Informatics .n the snarled areas <br />WASTE MANIFEST R S D 9 8 0 9 6 4 9 9 3I C 2 8 8 9 of 1 Is not requued by Federal law <br />I I 3. Generators Name and Marling Address National Electric, Inc. A. Slate Manliest Document Number <br /> P.O. Sox 935 - H1ry 169 N. <br /> Coffeyville, RS 67337 B. State Generator's ID <br /> d. Genaretor'sPnone( 316 251-6380 <br /> 5. Transposer 1 Company Name 6. US EPA ID Number C. Stale Transposer's ID <br /> National Electric, Inc. M N D 9 8 0 7 9 1 3 2 D. Transponer'sPhone 612-469-3475 <br /> 7. Transposer 2 Company Name 6. US EPA ID Number E. State Transposers ID ~. <br />l rF. Trensposere f•none I <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facilit~s ID <br /> PYROCHEM <br /> P.O. Box 907 H. Facilillrs Phone <br /> Coffe rile, RS 67337 R S D 9 8 1 6 0 5 316-251-4782 <br /> 12. Containers 13. 14. I. <br /> 11. US DOT Description (Including Proper Shipping Name, Hazard Class and ID Number) Total Unit Waste No. <br />c ,,,, No. T pe Ouantit WWoI <br />M 8. <br />E 10/4.54 <br />R <br />A Waste Pol chlorinated Bi hen is-ORM-fi DN2315 R TT 4343 <br />r b. 10/4.59 <br />0 <br />R <br /> Waste Polychlorinated Bi hen is-ORM-E 0172315 R O1 TT 20 <br /> c. <br /> d. <br /> J. Additional Descriptions for Materiels Listed Above ~ K. Handling Codes for Wastes Listed Above <br /> a. oil <500 ppm <br /> b. oil >i00 ppm <br /> 15. Special Handling lnstruclions and Addilionat Information Includes 19anifest ~'9t <br />2238E, 2484H, L1944, M1946, <br /> P1759, P1938, T2429, T2543 <br /> 16. GENER Ar OR'S CERTIFICATION: I h¢rlDy Declare That Ise contents 01 Ihis consignment ere Ivily ane accurately eescrihee above Dy <br /> proper shipping name ane pre classifies, pe<kee, markee, and IeDeiee. ane ere in all respects in props. poneition for transport Dy highway <br /> accoreing io epplicaDle inlernelionel end national gpvernmenl regulaiione. <br /> 111 em a large 0uanltly generator. I elilrly Thal I nave a program in place io retluce the volume end loaicity of rasl! pen¢relee to th¢ eegre¢ I have e¢lermmee to De <br /> economically practiceDle and IDaI I Dave s!Ilclee the Drsclicabl! melhoe of trealmeni, storage. or eisposal currently eveilaDle to me which minimires the preslnl ane <br /> luture threes to human health entl the environment; OR. it I em a smell guest enerator. I have mass a pane faith ellort to minimire my waste generelion ano select <br /> the 0lei waste management melhoe That is evailaDi! to me ane that I can all re <br /> Printed/7yped Name Sign Lure - Monrh Day Yeer <br /> Julie tialek I ~ a ~(~ <br />r <br />R '17. Transposer 1 Acknowledgement of Receipt of Materials <br />N Printetl/Typetl Name Si a e Mon <br />ts Day Year <br /> .S L.r-•.~ \ <br />e2 /~ <br />D <br />R iB. Transposer 2 Acknowledgeme of Receipt of Materials <br />T Printed/Typed Name Signature Month Day Year <br />E <br />R <br /> 19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 : <br />j 20. Facility Owner or Operator: Gertilication of receipt of hazardous materials coven tis manife ^cept as oted in Item 19. <br />r Printed N Signature Month Day Year <br /> d~ - <br /> <br />Style FI6REV-6 labelmaster. Div of American Labelmark Lo. Inc. 60646 <br />usw a:...... .., ~ .. <br />EPA Fov5s6700-22 (Rev. 9/a6) Previous eenions are obsol=le <br />