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<br />2200 CHURCHILL ROAD. SPRMGFlELD, RUNOIS 62706 (277) 782-6761
<br />IFO,., eerore a „sF m rn~ Itzolcro h0aw,nwl EPA Form 8700-2213-611
<br />1502-0610
<br />PM tPCeza/e1
<br />Fqm OMB Ib. 2000-O~OI E,Ofes 111.96
<br />A UNIFORM HAZARDOUS 1. Generator's US EPA ID No. / ^' est 2. age 1 kllomuri0r, n tm shaved areas is roe
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<br />WASTE MANIFEST K S D
<br /> 3. Generator's Noma end Mailing Address National Electric, Inc.
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<br />' P.O. Box 935 -Hwy. 169 No.
<br /> Coffeyville, Rs. 67337 ,
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<br />1. t3erleretar•s Pfrone( 316-2(1-6380 ~
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<br /> 5. Trerispbrter i COrr4anY Name 8. US EPA ID Nr+nber Y 1fMptxtsrl D _
<br /> Santa Fe I L D 0 0 6 9 2 8 5 4 3 B O 362-0393 TrBrportera P1lrxla
<br /> ~. Transporter 2 COnpany Name 8. US EPA ID M/nlber r D ~=~
<br /> N l: W V A D 0 0 0 6 5 0 3 0 9 ~ •065 ''~ Tpnttpbrtela PIIOTIe
<br /> 9. Desigleted FeeilNy Name end Site Address 10. US EPA ID Member );r%,~'~;-^j ,; -~ ..
<br /> SCA CHEMICAL SERVICES ;~. + r ~ 8
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<br /> 11700 S. Stony Island ~ pqw.?'~< s';~'';~:,a;; ~ .
<br /> Chicago, IL 60617 I L D 0 0 0 6 7 2 1 2 1 >,:~46-5700.: `^:,`~ ~ ~" '
<br /> 11. US DOT Description (Including Proper Shipping Name, Ha2ard Class, end ID Number) 12.Cmtaslers 13.
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<br /> 15.SpedalHandlinglnstructiorlsandAdditicrlallnfomlation Conte ns manifest A's 00032, 17066,A0027, A2508,A5266,
<br /> B0245,80386,00014,C1996,C5389A,C5389B,D0241,D5667,E2385,E5768,F0336,H0034,H0098,H0076,
<br /> H0439,H1638B,H5638F,H5732,R0099,IC0100,K0196,L0106,M2154,M5733D,N1968,N2575A,N5271,N5735,
<br /> W0331,W5666, P0040,PO110,P0417,Q1580,50147,T0356,T5257D,U0418,
<br /> See enclosed contin enc Ian
<br /> 16. OENERATORB CERTIFICATION: I hereby declare that the contents of ttris consigsrlent ere fully and aeeuatey described
<br /> above by proper dipping name 'nd are classified, padeed, marked, and labeled. and are h all respects h proper condition
<br /> for transport by~plrM6y according to applicable Imematiorel and national gavemmantal regJatibrls, and 61i1ois reguWtbns.
<br /> Date
<br /> Pdnted/Typed Name Sigrlatl-e Monfh Day Year
<br /> S.G. Hale Q~
<br />~ 7. Transporter 1 Ackrlovdedgement of Receipt of Materials Date
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<br />M Printed/Typed Name S' the Monfh Day Year
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<br />0 8. Transporter 2 Ack t or Receipt of Materials ~ Date
<br />i Printed/Typed Name Sknature Month Day Year
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<br />P 19. Discrepancy Ytdication Space
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<br />I 20. Facilit Owner or
<br />y Operator. Certification of recent of hazardous materials covered by ttlis meniled except es noted in
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<br /> Rinted/Typed Nema Signatlae Monfh Day Year
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<br />N RLMOIS: 217 / 762-3637 '24 HOUR EMERGENCY AND SPILL ASSISTANCE NUMBERS'
<br />OUTSIDE R.LaJO1S 900 / 4248602 ar 202 / 426-2675
<br />DISTRIBUTION PART - 1 GENERATOR PART - 21EPA PART - 3 FACeITY PART - 4 TRANSPORTER PART - 51EPA PART - 6 GENERATOR
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