Free 52717.pdf - Indiana

ANNUAL MANIFEST SUMMARY REPORT
State Form 52717 (R/8-06)

REPORT YEAR:

Indiana Department of Environmental Management

FORM OS
RCRA ID |_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|

OFF-SITE SHIPMENTS
Hazardous Waste Description
Waste Codes

GENERATOR NAME

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TSD FACILITY RCRA ID NUMBER 1

TSD FACILITY NAME LOCATION CITY AND STATE

QUANTITY SHIPPED AND UNIT OF MEASURE |_ _|_ _|_ _|_ _|_ _|_ _|.|_ _| pounds short tons kilograms metric tons |_ _|_ _|_ _|_ _|_ _|_ _|.|_ _| pounds short tons kilograms metric tons |_ _|_ _|_ _|_ _|_ _|_ _|.|_ _| pounds short tons kilograms metric tons |_ _|_ _|_ _|_ _|_ _|_ _|.|_ _| pounds short tons kilograms metric tons

MGMT CODE

# OF SHIPMENTS

REJECTED/ RETURNED

Yes |_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ | H|_ |_ |_ | |_ _|_ _|_ _| Yes Yes |_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ | H|_ |_ |_ | |_ _|_ _|_ _| Yes Yes |_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ | H|_ |_ |_ | |_ _|_ _|_ _| Yes Yes |_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ | H|_ |_ |_ | |_ _|_ _|_ _| Yes

No No No No No No No No

2

3

4

TRANSPORTER RCRA ID NUMBER

TRANSPORTER NAME

1 |_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ | 2 |_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ | 3 |_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ | 4 |_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ _|_ |

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