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NON-HAZARDOUS 1. Generator's US EPA ID Na. Manifest Doc. No. 2. Page 1 <br /> WASTE MANIFEST o1 <br /> 3. Generators Name and Mailing Address <br /> Energy Fuels <br />C <br />C~' <br />' <br />C d <br />~~ <br /> an <br />- <br />~ <br />O <br />X190 CR 92 <br /> a. Generator'sPhone(']19-y 84-6395 <br /> 5. Transporter t Company Name 6. US EPA ID Number A. Transportefs Phone <br /> Tvin Enviro Services 719-372-6671 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number e. Transponets Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone <br /> Energy Fuels <br /> 1190 County Road92 <br /> 719-782-6395 <br /> 1 i. Waste Shipping Name and Description 12. Containers Total UnR <br /> No. Type Ouantlry WWoI <br /> a. ~~ <br />G b. <br />E <br />N <br />E <br />R <br />A c. <br />T <br />O <br />R <br /> d. <br /> D. Atldilional Descdptions for Materials Listed Above E. Handling Codes for Wastes Lis[etl Above <br /> 15. Special Handling Instructions and AddiUOnal Information <br /> 16. GENERATOR'S CERTIFlCATON: I oerofy the materials deecdbeQabove an tltls mantlest are not subject to federal regulatlo for reporeng proper disposal at Hazardous Waste. <br /> r // <br />_ ~ ~ ~ •' V ~ zw,.rn OuY Year <br />R 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> <br />H PrintedrTyped Name Signature MwM Dar Yeer <br />S <br />P <br />R 18. Transporter 2 Acknowledgement of Receipt of Materials <br />E Printed?ypetl Name Signature Month Day year <br />R <br /> 19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />~ 20. Facility Owner or Operator. Certification of receipt of waste mate ' Is covergd by Nis ifest except es noted in Item 19. <br />T <br />y `'n _ lY <br /> Printed/T <br />yped Name ~ I Sign re <br />r <br />Monet pay <br />y„r <br /> ORIGINAL - RFTI IRN TA I:FNFRAT[1R <br />