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~e rlnt ar type. (Form tleaignetl for use an elite (12-pitch) typewriter.) <br /> <br /> <br />Form Approved. OMB No.2000-0404. Expires 7-31-e6 <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manilest Document No. 2 page 1 Information in the shaded areas <br /> WASTE MANIFEST P0040 of 1 is not required by Federal law. <br /> 3. Generators Neme end Meiling Address Pittsburg 6 Midway Coal Mining Co. A. State Manliest Document Number <br /> Hwy 131 - 3 mi. N Oak Creek Co. <br /> Oak Creek, CO 80467 8. Slate Generators ID <br /> 4. Wrnretore Phone <br /> 5. Trensporter 1 Company Name 6. US EPA ID Number ~ C. State Transpdrters ID <br /> National Electric, Inc. MND9f30791321 D. Transporters Phone 612-469-3475 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID <br /> ' F. Transporters Phone <br /> 9. Designated Facility Name end Site Address 10. US EPA ID Number ~ G. State Facility's ID <br /> National Electric, Inc. <br /> Hwy 169 No. Coffeyville, KS 67337 H. Fecllitya Phone <br /> KSD980964993 316-251-6380 <br /> 12. Conta iners 13. 14. I. <br /> 11. US DOT Description (Including Proper Shipping Neme, Hazard Class end 10 Number) Total Unit Waste No. <br />c No. T e Ouantit WWoI <br />n a. ~~__rf <br />e7/. <br />E 10/4.54 <br />~ Waste Pol chlorinated Bi henyls-ORM-E UN2315 RQ /~ <br />'T CM ~ ,7y P <br />T b. <br />O <br />a <br /> C. <br /> d. <br /> J. Additional Descriptions for Materials Listed Above ~ °" ° t "' "' ' K. Handling Codes for Wesles Listed Above <br /> <br /> a. transformers filled with >500 ppm <br /> 15. Special Handling Instructions and Additional tnlormation <br /> See Attached Sheets <br /> Ref. to W.O. NCJ500460 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare Ihat the contents of this consignment are lully and accurately described <br /> above by proper shipping name and are classified, packed, marked, end labeled, and ere in all respects in proper condition for <br /> transport by highway according to applicable international and national governmental regulations. <br /> Date <br /> PrintedRyped Neme Sign a Month Dey Year <br /> .I t~1a~ <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials Dale <br /> 9rinted7Ty <br />p <br />eed <br />N <br />arr) Signet <br />Month Dey Yeer <br /> ' <br />C <br />,- <br />C` <br />' <br />t I// ~. r <br />P <br />0 <br />16. Transposer 2 Acknowledgement of Receipt of Materials Date <br />a PrlntedlTyped Neme Signature Month Dey Yeer <br />E <br />e <br />. 19. Discrepancy Indication Space /~~ <br />Q . S! CM N,yocea7 > 50o Pp~. LK4. - /G~ !yS l~iS, <br />F <br />A <br />C <br />1 <br />~ 20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this menilest except es noted in Item 19. <br />r Dete <br />r <br />Prlnted/Typed Name <br />S <br />Signatur Month Dey Yeer <br /> o <br />K. - <br />Style FIS-e LebNmasler, Chlcego, IL 8~ <br />v ~ <br />O EPA Form a70D22 (384) <br />(1R1rg!AtgL - RETUfiM TO f~FN=BATOR <br />