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". . <br />~'" '" d R~E~EIVED MAR :~ 1 14gf~ <br />,rm desidned for use on a de (12~pgehl lVDewnter ; <br />Form Approvetl OMB No. 2000 0x0<. Expnes 7-3186 <br />~ t Generator's OS EPA 10 No. Manilest Dooument No <br />H <br />S 2 Pa e 1 <br />g lnlormahon in the shaded areas <br />KSD980964993 I CO515 <br />A TEST <br />xASTE <br />I 0l 1 is not required by Federal law. <br />,r'Generalors Name and Mailing Address National Electric, Inc. A. Stale Manilest Document Number <br />~ <br />~?`' P.O. Box 935 -Hwy 169 No. <br /> '~ Coffeyville, Ks. 67337 B. State Generator's ID <br /> n <br /> eretor'sPhone( 316 ) 251-6380 <br />4. Ge <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID NVTPCB-010 <br /> National Electric, Inc. MND980791321 D. Transporler'sPhone 612-469-3975 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Trensporter's ID <br /> F. Transponer's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> U.S. Ecology <br /> P.O. Box 578 H. Faciliy's Phone <br /> Beatty, NV 89003 NVT330010000 702-553-2203 <br /> 12. Conta iners 13. t4. I. <br /> 11. U3 DOT Description /Including Proper Shipping Name. Hazard Class and ID Number) Total UW l Waste No. <br />d T e y <br />ot <br /> a <br />E 10/4.5 ~} ~~TMS <br /> <br />A Waste Polychlorinated Biphenyls-ORM-E UN2315 R CM `497999 P 07- <br />t <br />0 b. <br />10/4.5 <br />R Waste Polychlorinated Biphenyls-ORM-E UN2315 RQ 2 CM 1,755 P 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 /> !l:'i/ 111T <br /> . total cubic feet ih62. <br /> t5. Special Handling Instructions end Additional lnlormation Contains manifest 9's 80245, B0386, C5389B, D5667, <br /> See enclosed contingency plan L0106, M0294, M2154, P0040, T5484A, U0140A, W0366, <br /> W0438, W1813 <br /> 16. GENERATOR'S CERTIFICATION: I 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, and are m aIV respects in proper condition for transport by highway according <br /> to applicable international and national government regulations. <br /> Unless I em a Small quantity ggenerator who has been exempted by statute or regulation from the duty to make a waste minimization certification <br />under Section 3002(b) of RCRA, I also certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree <br /> I have determined to be economically practicable and I have selected 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/Typed Name Signature , Month Day Year <br /> S.G. Hale t <br /> 7 <br />R 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Name Srgnatur Month Oa Ye <br /> v Ray Loeb 3 <br /> 0 <br />fl 16. Transporter 2 Acknowledgement of Receipt of Materials <br /> 7 Printed/Typed Name Signature Month Day Year <br /> E <br /> a <br /> 19. Discrepancy Indication Space /• •0.y 4,^~~ nK~L `~ '^~' t 1 /_ ~~/q <br />y <br />• <br />10.1 <br />`j)' <br />1r <br />E <br />JC <br />` a~ l <br />i <br />:'k <br />D <br />` <br />D <br />c y <br />2 <br />~ <br />~ <br />` <br />' <br />•~ <br />09ye.ht <br />tn,t.oereck pbcJ4 r3C~• <br />?• Corre~et3 <br />B~o <br />?~+ <br />- <br />t ~C <br />' <br /> 20. Facility Owner or Operator: Certification of receipt of hazardo aterials c red b his vilest din Item 19 <br />~ P inted/T ped N mp~ Sign Month Day Y r <br /> ' / -' <br /> <br />Style F15R-6 Labeimastei. Div. of American Labelmark Co. Inc 606u6 <br />~PA Form 0700~221Rev. 4651 Previous edition is obsolete. <br />N•~~ <br />n a: v)rnr r.o or'r: r^ra rn "cnrr rr v::vo <br />