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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