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State dfQq8fqthla— Call fqfrija EnWohm6niot P(OIN(lon Aganoy <br />Dep6"qnfof toxfoS6bsjan.cqs. trot (OTSO). <br />P4. tjQx 1188 <br />Sacramehic, 6A 056194288 <br />Generator Information Sem'cqs Section <br />1.877 464,4612 (Calif. Callert Ohly Tol rree) <br />of 1-916-265-4439 (Otililde Ca if, <br />WYv4t.discIcd,dov <br />SCHOULEA—MANIPESTIFEE,C <br />ALPULATION SHEET FOR -2000 MANIFEST$ <br />EPA.Ovuriiber; ca W(?0002 QrgAljiZajLbn,f4arnO,_ 1`104EERWAMOA5.116013A OLIN PHORALKALL PRODUCTS <br />f!(Jd.dra I Employer l0entiricat(ot) NuMb IN) REQUIRED—_13 - IP, -1 -:01 (Al§o called <br />d a Federal Tax'10.) <br />j! you do not Rave_dj <br />a MIN. p[eqss-proW_.p.Y,5tif Socl Ocu1tIty.NLfnqi;ljWF, <br />ubry :2669 ih'r'o*lj'a*ii.D6c.Q'mber.ZI,1608 <br />6t ft Hlhtfof the EPA 11) Wiftefr6hown iihb.vio. <br />Recyoled; :0 <br />If you -believe the rnanlfest count above Is4ricorrect, you may use Oje count fr6m,your own tflOs-,,OrQt. . s 6141 (fib <br />number(s).abDve and Insertyour revised . nluliftHqwav - .f(s). arj,p <br />je4se A016- hat.pydffference I>,Qtwe6h the <br />manitest counts you report and the manifeidl countoptirftod on Schedule A Is*i;vb1 audit b IYTSC, <br />Y. <br />To qvallfy.as t­OQjcIoOj,aII Ii6espir waste 0n_Rle Pfunif0st must be:recycled. The hazardous waste dfspqsaffacillty <br />eddii�o6do.COIKe.M46ifett'lo.iifdlcEitd,'Jtwiisrobycledeltheir:facility. The recycling codes cqn,be-found in.bo'x 19 <br />on -the tn6hifest and tiro 1-1010, H020, H039, H050, or -H061. In sorris cases,: the InIllal receiving facility only Ir6n§fers <br />W010'(4 a handle,lhe waste. Ybu can contact your hazardouswaste <br />itanObitet or disposal fric.11119 for hien information. if you clalrh'that waste was reoycled that IsmWocurnenfedon a <br />manifest, DTSCmay Ask tar 'iiddillbrialdautTi6taU6A. [moolthritt Plailsodono Include t r1cl our recycling <br />Keep (hese documents with your <br />a. tinter the tiornbet Of 4011146c.ViOled ftlanlf6st,% from above, <br />tinterlbo riUrnber of noir-recycled manifests that were <br />Ped solely <br />601vanis". You -vA8etern1jnpftfsnumber u.s tiq your fqoords.. <br />Refer to trist(uctions.on back for moralpfomal[lorl on mr.O.Mpliart6e <br />s6lvonis. <br />o. Sobtra.cf,tho_numberoY.manit"ts,�on- Line-,bi from Lima.., and "tor hero. <br />x $7..`50 X1. 9n <br />A Vo fee due f0r,rer,yfftd manifest : <br />(Aj111(j1d�: dfikaste Q_h the r0ahilest rhu9t b6 43ydfed.) <br />e. Total Wnlfbst Fee Due. <br />.0116 (he $Amaunts. O.WnOsb. and. c.) Ni <br />The manifestcountin boxes bi and o. shoWd.equal-the,ountinz-box <br />1`168.s6 note That even If you do not Owe -fees, you.ars'efilfrequired to return AL CorM!j__tO_r)TS <br />C.- <br />FRE141.1115INITILY A800 OUESTIJON5 <br />.In &061-10 601at-YO.Oh completing theformi, we have compiled answers to common questions about the Verification <br />Cludst[Ohna.46,an-clFba MsassrnenK Ybu can access the 'Frequently Asked Questions* on our web.91te at <br />www-4vc'03,,goV. Under "Information for Public*, select 'Frequently Asked Guaitions','end then select "2009 <br />VerlqbOon.QOestionnaire FAW. <br />(Insfmollohs bn bact?) <br />OT80 1194X(4109) <br />