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RECE~vErJ APR 1 1 1986 ~6oY0'~-Dogs f- <br />aia~~a%dni n. rvna rFnrm na~innan In. nca nn ekm n9.nnch7 rvrvwdter : Foim Aoo.ovetl OMB No 2000-0x04. E.oves 737.86 <br /> t. Generator's US EPA ID No Manifest Document No <br />UNIFORM HAZARDOUS 2 Pa e t <br />9 Information in the shaded areas <br /> WASTE MANIFEST Ic S D 9 8 0 9 6 9 9 9 3I C0575 0l 1 is not required by Federal law. <br /> 3 Generator's Name and Mailing Address National Electric, Inc. A. Slate Manifest Document Number <br /> P <br />O <br />Box 935 -Hw <br />169 No <br /> . <br />. <br />y. <br />. <br />Coffeyville, Ks, 67337 <br />B. State Generator's ID <br /> 4. Generator's Phone( 316 251-6380 <br /> 5. Transporler~t Company Name 6. US EPA ID Number C. State Transporter's ID NVTPCB-083 <br /> Environmental Transportation Serv, O K D 9 8 1 0 5 6 7 9 D. Transponer'sPhone 800-654-8622 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State TranspOrler's ID <br /> F. Transponers Phone <br /> 9. Designated Facility Name and Site Atldress 70. US EPA ID Number G. State Facility's ID <br /> U.S. Ecology <br /> P.0. Box 578 H. Facility's Phone <br /> V T 3 3 0 0 1 0 0 0 0 702-553-2203 <br /> 12. Conta iners 13. 74. I. <br /> 1 t. US DOT Description (Including Proper Shipping Name, Hazard Class and 10 Number) Total Unit Waste No. <br />b „ No. T e Ouantit WWoI <br />w a. 10/4.54 <br />E Waste Polychlorinated Biphenyls-ORM-E UN2315 RQ 9 CM 41,075 P 7-001-2034 <br />R <br />A <br />T b. 10/9.54 _ <br />O <br />B <br />Waste Polychlorinated Biphenyls-ORM-E UN2315 RQ <br />1 <br />M <br />1,095 <br />P <br />07-001-2034 <br /> c. <br /> d. <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> A. Transformers drained 6 flushed Cat. C <br /> B.~Transformers drained ~ Cat. D ~ ~~ ~ ~ ~ . <br /> ~~ Sotal cubic feet 932. <br /> 75. Special HandlinglnstructionsandAdditionallnlormation Contains manifest #'s C2036, F2351, M0355, <br /> M0419, P0040, 00095, W0065, W5666 <br /> See Enclosed Contingency Plan <br /> 76. GENERATOR'S CERTIFICATION: f hereby declare that the contents of this consignment are fully and accurately described above by proper <br /> shipping name and are classified, packed, marked, and labeled, antl are in all respects in proper contlnion for transport by highway according <br /> to applicable international and national government regulations. <br /> Unless l am a small quantity ggenerator who has been exempted by statute or regulation Irom the duly to make a waste minimization certification <br />untler Section 3002(b) of RCRA, I also certify that ! have a program in place to reduce the volume and toxicity o! waste generated to the degree <br /> I have determined to be economically practicable and I have selectetl the method of treatment, storage, or disposal currently available to me <br /> which minimizes the present and future threat to human health and the environment. <br /> Printed(lyped Name Signature Month Day Year <br /> S.G. Hale <br /> r <br />R 17. Transporter 1 Acknowledgement of Receipt of Materials <br />A Printed/Typed Name Si _ Month Day Year <br />s <br />P Alan Butterworth ~~, p <br />0 <br />a 18. Transporter 2 Acknowledgement of Receipt of Materials <br />r Printed/Typed Name Signature Month Day Year <br />E <br />R <br /> 19. Discrepancy Indication Space <br />F <br /> <br />C <br />I <br />L <br />I <br />20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by t s manila t e apt noted in Item 19. <br />r Printetl/T petl Name Signat /_ Month Day Year <br />` <br /> ~. r 7 <br />.~ <br />Style F76 ~6 Labelmaster. Drv. of American Labelmark Co. Inc. 60646 EPA Form 6700-22 (Rev. d-65) Previous etlition is obsolete. <br />r.nv~ter nr r..~rn^ai ^n GCntt..v hTtlR ' <br />