Document KG8ZXqx35Mwq3Lj9KzKbn1VN2
SCI 03068
NAME OK RECEIVING TSl) FAC I LIT:
EPA I.0. NUMBER: G A
FROM WHOM RECEIVED: NAME:
EPA I.D. NUMBER: __________
HAZARDOUS WASTE RECEIVED FROM OFF-SITE HANDLERS AND ITS DISPOSITION
1. EPA Hazardous Waste Number
2. Description of Waste
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11 111
111
11
3. On Hand, On-Site on Jan. 1, 198b
4. Received Durinq 1985
5. TOTAL Amount for Which to Account 6. Reshipped to:IDf
Name: 7. Reshipped to:IDf
Name: 8. Reshipped to:ID#
Name: 9. Reshipped to:ID#
Name:
10. Treated On-site
11. Treatment Code
12 Disposed of On-site
13. Disposal Code
14. On Hand, On-Site on Dec. 31, 1985
15. Storage Code
16. Other (Explain on Line 17)
17. Explanation of Line 16
18. TOTAL Amount of Disposition Comments:
Page
FORM C TOTAL IN TONS
of