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14ON•HAZARDOUS 1•Generator ID Number 2,Paga 1 of 3.Emergency Response Phone A.14aste Tracking Number <br /> WASTE tdANIFEST f a l•t ktt�:r5�jfric•+.r i !;i :: :_ •, �•�{� __ `; <br /> Ct Generalor's llama end Idalling Address Genelalors SRR Addreso jr!difleren(then meting zTres:) <br /> 00101 u r t,. J, , u;-�- '•, , ;1 uwt r':Vwfty 4 b t <br /> "5V O"k- o Orkw.Itxuad? IN 4OH8 4146 Urn,CIA PPOY <br /> Generalors Phone:_ I _ <br /> 6.Transpoder i Company Name U.S.EPA ID IJumber <br /> A'zr&,."f?t fft: ;.+fid fl"+'i_ kw, C,'��2CC01 <br /> 7.Transporter 2 Company I lame U.S.EPA ID Humbn <br /> 6.DeslW_Wod Facibly Hame and Site Address U.S.EPA ID Number <br /> iFi.499rV;P.iiLuri;iNl <br /> M Raow RC4-' fy.a RrA Roqu;rid <br /> FRCif�sPliona: <br /> 9.Waste Shipping Name and Description 10.Containers 11.Total 12,Unit <br /> No. Type 4ranU(y WfNaf. <br /> 1 <br /> MxWr. tH dou V%,W AM(Z7t9i) <br /> 2. <br /> Received <br /> 03/26/15 <br /> 3. --CRA, INC. <br /> Indianapolis <br /> 4. <br /> i <br /> 13.Spacial HRndling lnslructions and Additional lnfotmallon I _ett'i�1?: t r!tv.i I <br /> WAN*{?IOW AW��lt� SAW 1�W �`S ilT'4 ii'!'-t <br /> rat»KIP '':. 24 t vw ecn+ eericy MnAmr W- 0 04-M4 tr+Pfc : +0719 <br /> 4 rttittwa, f'c+r k 07W411)W�16341U <br /> J-5165 <br /> 14.GENERATORMFFEROR'S CERTIFICATION:I hr;tb defte 1!x110o collants of flit vwt:Vrnu:nl are bLy and trccwa'efy 6%di>d>beet ty tl»E•spur ElipEing name,aril Rra tl a�Tio9,p.rr.gad, <br /> marled and labe!ed,'piawfded,and are In ab respecls in prupar conoillun for transport aa;oraing to opprcable Inlemadonal and na*ji gq"va!nmenial regulations. <br /> Gener * <br /> lofs1011eror'e Prirrl@dT rte Signature J \ Month Day Year <br /> :"4�,�r'.,E-1••'•;trr,tiN <br /> IS.International Sldpments — t t� <br /> ❑Import to U.S. ❑Export from U.S. Port oI enliylexll:_ <br /> Transporter Sl alum for exports on : Dale leaving U.S.: <br /> 16.Transporter Acknoviedgment of Receipt of ldalerlals <br /> Transporter Pdnted/TyltsdName Signature , Month Day Yav <br /> l� � ter rl.�•fr,:i;hC�4 iL. `,,•.�fi � •f ' a<_ <br /> Transpoiter 2 Printed,Typed Nmne ftnature t Month Day Year <br /> 17.Discrepancy <br /> 17n.Discrepancy Indical!on Space <br /> ❑Quantity El Type IJ Residua ❑Panlal Ra)adian El Full Reiccllon <br /> Mwdfesl nefelonce Number: <br /> 17b.Nlemalo Facilily(or Generator) U.S.EPA ID Number <br /> Facility s Phone: I__ <br /> 17ca Slanalure of Allornale Facility(or Genemlor) ticvah Ixy Year <br /> I(i,O?:lglrirlyd�A`'.Ily�ilhfr a UI!:IJIar.C911UI:hUit101 rl bei I d rfrdrife!5 cr.�slo0 6y 11+?I11A'IIIP:S Ex(Y'{E rGi IrUlyd IR gCt}I 17a <br /> PrintedR'ypcd Nama l r ( Signature , Mongn Day fear <br /> TRANSPORTER M <br /> y109•134C•0 5 11977(R.,.91091 <br />