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U.S.EPA Form 8700-22 Note:If additional space is needed for waste descriptions,enter these additional descriptions
<br /> Read all instructions before completing this form. in Item 27 on the continuation sheet(EPA Form 8700-22A).Also,if more than one
<br /> 1. Federal regulations require generators and transporters of hazardous waste and owners or Emergency Response phone number applies to the various wastes described in either Item
<br /> operators of receiving facilities designated- n the manifest to complete this form(EPA Form 9b or Item 27,enter applicable Emergency Response phone numbers immediately following
<br /> 8700-22)and,if necessary_,the continuation sheet(EPA Form 8700-22A)for both inter- the shipping descriptions for those Items.
<br /> and intrastate transportation of hazardous waste. Item 10.Containers(Number and Type)
<br /> 2. This manifest reflects formatting changes made by U.S.EPA in December 2017, Enter the number of containers for each waste and the appropriate abbreviation from Tao
<br /> Beginning on June 30,2018,this manifest(Revision 12-17)must be used and all (below)for the type of container.
<br /> previous editions are prohibited.Go to www.epa.gov/e-manifest for additional TABLE I.-TYPES OF CONTAINERS
<br /> information. BA=Burlap,cloth,paper,or plastic bags. DT=Dump truck.
<br /> 3. This form must be purchased from a registered printer CF=Fiber or plastic boxes,cartons,cases. DW=Wooden drums,barrels,kegs.
<br /> (hftps://www.epa.gov/hwgenerators/approved-registered-printers-epas-manifest- CM=Metal boxes,cartons,cases(including roll- HG=Hopper or gondola cars.
<br /> registrytlhow)and has been designed to be filled out using standard computer printers;a offs).
<br /> firm point pen may also be used-press down hard.After June 30,2018,this form can also CW=Wooden boxes,cartons,cases. TC=Tank cars.
<br /> _be completed electronically in EPA's e-Manifest system. CY=Cylinders. TP=Portable tanks.
<br /> The public burden related to me Uniform Hazardous Waste Manifest,which is approved underOMB 205M039.is estimated to average(per manifest)60
<br /> i DF=Fiberboard or plastic drums,barrels,kegs. TT=Cargo tanks(tank trucks).
<br /> mirutes forgene:ate!s;20 mnu(es for transporters;aid 30 minutes forovmersaM operamsuf receir:ng facilities designated on the manifest.This isa i
<br /> mandato, collnciionunder40CFRPar'262Sub d8,40 CFRPad263,Su DM=Metal drums,barrels,kegs.
<br /> y pa Subpart!3.and40CFR Pads264 and 265,Subpart E.An agency may not g
<br /> conductor sponsor,and a person is not required to respond to,a collection of mfomralronunless it displays a currently valid OMB control number The , Item 11.Total Quantity
<br /> completed brm should be submitted in accordance wim the instructionsaccwnpanying the form,oras specified in the corresponding regulation.Send I
<br /> Enter,in designated boxes,the total quantity of waste.Round partial units to the nearest
<br /> comments on the Agency's need for tris information,the accuracy of the provided burden estimates,and any suggested methods for minimizing respondent
<br /> burden,ink!udinthroughtheuseofe-Manifest.totheDireder,Cotecton whole unit,and donotenterdecimalsorfrac#ions.Totheextent practical,report quantities
<br /> g Strategies Division,U.S.Environmental Protection Agency 12822T),1200 p p q
<br /> IPennsylvania Ave.,NW,Washington.D.C.20160.Please indudeMe OMBcenlrol numherin any correspondence.Do NOT send the completed manifest using appropriate units of measure that will allow you to report quantities with precision.
<br /> forms to this address.Privacy Act Statement-None oftre infnrmalronmpectedrmdertfreNanifest Program is considered Personally Identifiable Waste quantities entered should be based On actual measurements Or reasonably accurate
<br /> nformation Prr)nrConfidential Business Inemraren(ce). estimates of actual quantities shipped.Container capacities are not acceptable as estimates.
<br /> I.Instructions for Generators Item 12.Units of Measure(WeighWolume)
<br /> Item 1.Generator's U.S.EPA Identification Number Enter,in designated boxes,the appropriate abbreviation from Table II(below)for the unit of
<br /> Enter the generators U.S.EPA twelve-ifigit identification number,or the state generator measure.
<br /> identification number if the generator site does not have an EPA identification number. TABLE II.-UNITS OF MEASURE
<br /> Item 2.Page 1 of_ G=Gallons(liquids only). N=Cubic Meters.
<br /> Enter the total number of pages used to complete this manifest(i.e.,the first page(EPA Form K=Kilograms. P=Pounds.
<br /> 8700-22)plus the number of continuation sheets(EPA Form 8700-22A),if any). L=Liters(liquids only). T=Tons(2000 Pounds).
<br /> Item 3.Emergency Response Phone Number M=Metric Tons(1000 kilograms). Y=Cubic Yards.
<br /> Enter a phone number for which emergency response information can be obtained in the event Note:Tons,Metric Tons,Cubic Meters,and Cubic Yards should only be reported for very
<br /> of an incident during transportation.The emergency response phone number must: large bulk shipments,such as rail cars,tank trucks,or barges.
<br /> 1. Be the number of the generator or the number of an agency or organization who is Item 13.Waste Codes
<br /> capable of and accepts responsibility for providing detailed information about the Enter up to six federal and state waste codes to describe each waste stream identified in Item
<br /> shipment; 9b.State waste codes that are not redundant with federal codes must be entered here,in
<br /> 2. Reach a phone that is monitored 24 hours a day at all times the waste is in transportation addition to the federal waste codes which are most representative of the properties of the
<br /> (including transportation related storage);and waste.
<br /> 3. Reach someone who is either knowledgeable of the hazardous waste being shipped and Item 14.Special Handling Instructions and Additional Information0
<br /> has comprehensive emergency response and spill cleanupAncident mitigation information 1. Generators may enter any special handling or shipment-specific information necessary
<br /> for the material being shipped or has immediate access to a person who has that knowledge for the proper management or tracking of the materials under the generators or other
<br /> and information about the shipment. handlers business processes,such as waste profile numbers,container codes,bar
<br /> Note:Emergency Response phone number information should only be entered in Item 3 when codes,or response guide numbers.Generators also may use this space to enter
<br /> there is one phone number that applies to all the waste materials described in Item 9b.If a additional descriptive information about their shipped materials,such as chemical
<br /> situation(e.g.,consolidated shipments)arises where more than one Emergency Response names,constituent percentages,physical state,or specific gravity of wastes identified
<br /> phone number applies to the various wastes listed on the manifest,the phone numbers with volume units in Item 12.
<br /> associated with each specific material should be entered after its description in Item 9b.
<br /> Item 4.Manifest Tracking Number 2. This space may be used to record limited types of federally required information for which
<br /> there is no specific space provided on the manifest,including any alternate facility
<br /> This unique tracking number must be pre-printed on the manifest by the forms printer. designations;the manifest tracking number of the original manifest for rejected wastes
<br /> Item 5.Generators Mailing Address;Phone Number and Site Address and residues that are re-shipped under a second manifest;and the specification of
<br /> Enter the name of the generator,the mailing address to which the completed manifest signed polychlorinated biphenyl(PCB)waste descriptions and PCB out-of-service dates required
<br /> by the designated facility should be mailed,and the generators telephone number.Note,the under 40 CFR 761.207.Generators,however,cannot be required to enter information in
<br /> telephone number(including area code)should be the normal business number for the this space to meet state regulatory requirements.
<br /> generator,or the number where the generator or his authorized agent may be reached to Item 15.Generator'sJOfferor's Certifications
<br /> provide instructions in the event the designated and/or aftemate(if any)facility rejects some or 1.The generator must read,sign;and date the waste minimization certification statement.In
<br /> all of the shipment.Also enter the physical site address from which the shipment originates signing the waste minimization certification statement,those generators who have not
<br /> only if this address is different than the mailing address. been exempted by statute or regulation from the duty to make a waste minimization
<br /> Item 6. Transporter 1 Company Name,and U.S.EPA ID Number certification under section 3002(b)of RCRA are also certifying that they have complied
<br /> Enter the company name and U.S.EPA ID number of the first transporter who will transport the with the waste minimization requirements.The Generator's Certification also contains the
<br /> waste.Vehicle or driver information may not be entered here. required attestation that the shipment has been properly prepared and is in proper
<br /> Item 7.Transporter 2 Company Name and U.S.EPA ID Number condition for transportation(the shippers certification).The content of the shipper's
<br /> If applicable,enter the company name and U.S.EPA ID number of the second transporter certification statement is as follows:"I hereby declare that the contents of this
<br /> who will transport the waste.Vehicle or driver information may not be entered here. consignment are fully and accurately described above by the proper shipping name,and
<br /> If more than two transporters are needed,use a continuation sheet(s)(EPA Form 8700-22A). are classified,packaged,marked and labeled/placarded,and are in all respects in proper
<br /> Item 8.Designated Facility Name,Site Address,and U.S.EPA/D Number condition for transport according to applicable international and national governmental
<br /> Enter the company name and site address of the facility designated to receive the waste listed regulations.If export shipment and I am the Primary Exporter,I certify that the contents of
<br /> on this manifest.Also enter the facility's phone number and the U.S.EPA twelve-digit this consignment conform to the terms of the attached EPA Acknowledgment of Consent,"
<br /> identification number of the facility. When a party other than the generator prepares the shipment for transportation,this party
<br /> Item 9.U.S.DOT Description(including Proper Shipping Name,Hazard Class or Division, may also sign the shippers certification statement as the offeror of the shipment.
<br /> Identification Number,and Packing Group) 2. Generator or Offeror personnel may preprint the words,"On behalf of in the signatur
<br /> Item ga.If the wastes identified in Item 9b consist of both hazardous and nonhazardous block or may hand write this statement in the signature block prior to signing the
<br /> materials,then identify the hazardous materials by entering an"X"in this Item next to the generator/offeror certification,to indicate that the individual signs as the employee tit
<br /> corresponding hazardous material identified in Item 9b. agent of the named principal.
<br /> Item 9b.Enter the U.S.DOT Proper Shipping Name,Hazard Class or Division,Identification Note:All of the above information except the handwritten signature required in Item 15 may be
<br /> Number(UN/NA)and Packing Group for each waste as identified in 49 CFR part 172.Include pre-printed.(Handwritten signatures are not applicable if the generator is preparing and signing
<br /> technical name(s)and reportable quantity references,if applicable. an electronic manifest using EPA's e-Manifest system.)
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