ANNUAL MANIFEST SUMMARY REPORT
State Form 52718 (7-06)
REPORT YEAR
Indiana Department of Environmental Management
FORM WG
WASTE RECEIVED FROM OFF-SITE Waste #1
Hazardous Waste Description: EPA Waste Codes: Generator RCRA ID# Generator Name and Location Address Quantity Received Unit of Measure Mgmt Code H
RCRA ID TSD FACILITY NAME
Waste #2
Hazardous Waste Description: EPA Waste Codes: Generator RCRA ID# Generator Name and Location Address Quantity Received Unit of Measure Mgmt Code H
Waste #3
Hazardous Waste Description: EPA Waste Codes: Generator RCRA ID# Generator Name and Location Address Quantity Received Unit of Measure Mgmt Code H
Waste #4
Hazardous Waste Description: EPA Waste Codes: Generator RCRA ID# Generator Name and Location Address Quantity Received Unit of Measure Mgmt Code H
Waste #5
Hazardous Waste Description: EPA Waste Codes: Generator RCRA ID# Generator Name and Location Address Quantity Received Unit of Measure Mgmt Code H
Copy this page for as many wastes as needed.
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