REV05714

• Permit No: C1981014
• IBM Index Class Name: Revision
• Doc Date: 1/21/2003
• Doc Name: Documentation regarding Hazardous Waste removal and portal sealing
• From: Energy Fuels Coal Inc
• To: DMG
• Type & Sequence: SL2
• Media Type: D
• Archive: No

'~rJ"~y'i... i hi r.
Ss ~ y~
r Y4cs.
ifs'.'.
t. ;
~, ~
1."Oeneratofs US EPA ID No. Manliest Doc. No.
~•,~
'~
NON=~jA~FjpOV$ ~ ~ 2. Page 1
_
y
' .`'~.~YVASTE MANIFEST ~' ~ Dt
3. Generrgo7e Name
antl Mailing Address
,
y
(
a. Generators Phone ( l (4'! T S~~ b d 7
5. Tran er C arty Name 6. US EPA ID Number A. Transportefs Phone
s
l `
7. Transporter 2 Comparry Name 8. US A ID Number
~ B. Transportefs Phone
9. Desgnated Fadliry Name and Site Address 10.
US EPA fD Number C. Facility's Phone
r 11. Waste ShiPPing Name and Description ~ - 12. Containers 13.
ToWI 14.
Unit
-~ No. Type Ouantiry WWoI
G S So ~ ~ `~ yca~1
,'
G b. "~
E
N
E
R
A
T c. ~
1~._
0
R '
d. ,

D. `Additional Descriptions for Matedals Listed Above E. Narldling Codes for Wastes Listed Above
15. Special Hantlling Instructions and Additional Information
16. GENERATOR'S CERTIFICATION: 1 certify the materials described above on this manifest ere not subject t0 federal regulations for reposing preper disposal of HazaAOVS Waste.
Pdnted/typed Name Signature Monts Day Year
R 17. Transporter 1 Acknowledgement of Receipt of Materials

A IItB yped Ndme - MOn)h Day Year
s ~u ezn / O
P
O
78. Transporter 2 Acknowledgement of Rece"ipt of Materials
R
E PdntedRyped Name Signature MonNr Day Year
R
t9. Disnapancy Indication Space
F
A
C
1
~ (
y
20. Facili
ceipt of waste materials covered by mis manifest except as notetl in Item 19.
Owner /or Operator. Certification o
f re
~
}
/
c
)
Y Pdntetl/T tl Name Sig
/ C
~ ' ~ ~
~
~G Month Da
' Year
P-%
-
~~ ICI ~
9
~~,..,
-
1~., TRAIiJSPGRTERsR1