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.-lease pri t or type. (Form tlesiynetl for use on elite (12~pilch) typewriter )
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<br />Form Approved. OMB No. 2000-0404. Ezpiras 7-01-e6
<br /> 1. Generator's US EPA ID No. Manliest Document No
<br />UNIFORM HAZARDOUS 2 Pa e 1 Information in the shaded areas
<br />
<br />WASTE MANIFEST x s D 9 e o 9 6 4 9 9 3I C0437 i
<br />0l is not required by Federal law.
<br /> 3. Generators Name end Mailing Address National Electric, Inc. A., State,Menllest Document Number
<br />
<br /> P.O. Box 935 -Hwy. 169 No.
<br /> Coffe villa, Ks. 67337 B~SteteGeneretorslD.'.:?
<br /> 4. Generators Phone 316 251-6380 -
<br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transponers ID NVTPCB-
<br /> Environmental Transportation Serv. O K D 9 8 1 0 5 6 7 9 D.~TrenaportersPhonel-800-659-6622
<br /> 7. Transporter 2 Company Neme 6. US EPA ID Number E. State Transporter's ID NVT PCH-083
<br /> F.•~TranaponersPhone ,
<br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facllity'e ID' ~ ~ ~ ~ '
<br /> U.S. Ecology ,'~~';l:y ':'r-,` +,~;.,.~,r:. .
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<br /> P.O. Hox 578 M;'FeclllyePhonetP''="'~ `~"
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<br /> Beatty, NV 89003 N V T 3 3 0 0 1 0 0 0 ~`~:702=553-2203" •
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<br /> 12. Conta iners 13. 14. I.
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<br /> t t. US DOT Description (Including Proper Shipping Neme, Hazard Class end ID Number) Total Unit ;'
<br />:: Waste No. .
<br />o No. T e Ouenlll WWoI ~"~-':
<br />x e' 10/4.5 y.a: ;i'v..'.',c... ,.
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<br />e Waste Polychlorinated Biphenyls-ORM-E UN2315 RQ 17 CM 73
<br />42 P 07-001-2034
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<br />t b. 10/4.5 .M~,'m~!r;:5:41t4~w'f'',:
<br />n Waste Polychlorinated Biphenyls-ORM-E UN2315 RQ 1 CM 335 P 07-001-2034
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<br /> J. Addl Ional Descriptions for Materials Listed Above ~ ~ ~:'' ~'~ '' °4'"' ~=+f+~ ",
<br />'~sE K;'HaMlin Codes to Waelea Listed Above
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<br /> ~ATraneformera drained fi flushed Cat I C ' r~,r
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<br /> 15. SpeclalHandlinglnslructionsandAdditionallnformation Contains manifest A'e 17086,C0175,C5389,C5389A,D0241
<br /> D5667,H5223,J2379A,P0090,55228,W0253,W2066
<br /> See Enclosed Contingency Plan
<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 IaDeled, and are in all respects in proper condition for transport by highway according
<br /> to applicable international and national government regulations.
<br /> Unless I am a small quantity ggenerator who has been exempted by statute or regulation Irom the duty to make a waste minimization certification
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<br />so certify that I have a program
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<br />n place to retluce the volume and toxicity of waste generated to the degree
<br /> I have determined to De economically practicable and 1 have selected the method of treatment, storage, or disposal currently available to me
<br /> which minimizes the present antl future threat to human health and the environment.
<br /> Printed/Typed Name Signatu Month Dey Year
<br /> S.G. Hale
<br /> r
<br />R 17. Transporter 1 Acknowledgement of Receipt of Materials
<br /> N Printed/Typed Name Si nature Month Dey Yea
<br />r
<br /> v Richard Waters /
<br />p e G ~j-
<br /> n 16. Transporter 2 Acknowledgement of Receipt of Materials
<br /> E Printed(Typetl Name Signature Month Oay Year
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<br /> 19. Discrepancy Indication Space
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<br />r 20. Facility Owner or Operator: Certification of receipt of hazardous materials cove by t 's hest e s noted in Item 19.
<br />r Printed/Ty ed Na a
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<br />Style F15R-6 Lebelmaster, Div. of American labelmark Co. Inc. 60646 EPA Form 8700-22 (Rev. 4-65) Previous etlilion is oDSOlete.
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