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<br /> U,S.EPA Form 8700.22 Item'10.Containers(Number and Type)
<br /> Rued'dlFln's'liuetiorle;bhforedidmpielifjg'Ihlsforrp,: „- •_ Enter thenumber6FcontalrSBlafoi,eechreit"sfe'arid.tfteappYdpiiatg`al25ftvfifioFt.lit6pflgi�A$ '
<br /> r .. t....__._ !
<br /> 1.,This form has been designed foru'se on a 17-pilch"(eltte)typewatet which is al'sdreofnpatible''l` ( '}for the type of container. -
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<br /> :with Standard computer printers;a firm point pen mayialso be used=press down hard. " TABLE I.--TYPES OF'CONTAINERS.''
<br /> 2.i Federal regula(lons require generators end ira4sportarsrof hazardous:waste 2nd owneis:or BA=8urtap,cl6fti paper,or plastic tiegs, t,�rlllTA;' U61p;tfUGk. -;r. i ; t
<br /> toperators of hazardous waste treatment,storage,and disposal facilliles to complete this form CF=Flberorplestic boxes,cartons,cases. _ DW=Wobdendiums,barrels,(cegsi
<br /> (EPA Form 8700-22)and,if necessary,the continuation sheet(EPA Form 8700-22A)for CM=Metal boxes,cartons,cases(including HG:=Hopper or gondola cars. i I I
<br /> both Inter-and Intrastate transportation of hazardous waste. .•` roll-offs). ', t
<br /> CW=Wooden boxes,cartons,cases. TC`Tank care.,,;r,
<br /> Publlcrepouing•burden for this out lectiorrof bdormatiari ls estimated to average:-aD nllnulae for gegerelors,10 _••.•.--. �..:
<br /> n;_...,: CY-=Cylindefs: '"TP.n;t?prtable lanks.l,,.,
<br /> minutes for transporters,and 25 minutes for owners or operators o(Ireahnent,storage,and dlspogal facilities.This DF=Fiberboard or plastic drums,barrels,kegs. TT=Cargo tanks(tank trucks),!
<br /> ' k&udeL time for revlewing Instructions,gslhefing dale,compleung;reviewing and lranamilllng the form.Any - •
<br /> ..DM-=Metal drums,.banAs,.kegs_.
<br /> cdrrespondence regarding the PRA burden stalemenFfor Ihe.manlfesl must be sentlo the Director of the Collection "� �, �.�,;�;": •;;.�;,.;r,,,t.,[ ''i
<br /> strategies DNlslon in EPA's office of Information Collection at the following address:U.S.Environmental Item 11.Total Quantity i
<br /> Prolectlon Agancy(2622T),.1200 Pennsylvanla Ave.,NW.,Washington,DC 20460. Do norsend... ._ Enter;indesl noted boxes,the total quantity of-was a -U �' "
<br /> the completed form to this address. -'`•�'I r'ais 9 q ty .ti, RUU�d;parltal,niteltor e.geB fefA i
<br /> whole unit,and do not enter decimals or fracllons, dtfie extent Pati ical,report quan les r
<br /> I,Instructions for Generators using appropriate units of measure that will allow you to report quantities with precision. i
<br /> Waste quantifies entered should be based on actual measurements or reasonably accurate'
<br /> Item 1.Generators U.S.EPA identlficatlon Number estimates of actual quantities shipped. Container capacities are not acceptsbfas.estjlmates.
<br /> Enter the generator's U.S.•EPA.Wlva digit Identification number,or-the Siale gene(alor item 12.Units of Measure(WeighWolume) o°i
<br /> identification number if the generator site poesmot have on EPA klentilloalloWnumber. Enter;in'de's/ nated'6oxae;t}ie a 'io date�atibrevlefidrj optlTAbje`(''�taloW;�pr`Iha'unitof
<br /> Item 2.Pae 1 of 1:w ra •»� „v t r g cab'P 1(u //r,r r c
<br /> .8.. ._._ _ I t]' , .rat ! measufe... ...... .._...... .......... .. . ...�:`. ,).',..'..._�,Ih', .);
<br /> Enter the total number of pages used to complete this Mgnifest(le.,the first page(FrPA Form T TABLE II.-UNITS-OF MEASURE
<br /> 18700-22)plus the number of Continuallo Sheets(EPA Form 8700.22A),if an '
<br /> Item 3.Emergency Response Phope Number 1 1. ! ' y) ff
<br /> G= Gallons(liquids only). N=Cubic Meters. I
<br /> t K=Kilograms. P=Pounds. ..
<br /> I Enter a phone number for whIch'emerger)cy response Informadon can be obtained m ttWevrenf L_Liters(llqulds.only}: _`_ __ - T=Tons(2000:Pounds)
<br /> j of an incident during transporla4on. The pergency resplonse phone number must; M=Metric Tons(i 066 kilograms}, Y=Cubic Yards.
<br /> 11. Be the number of the generator or the humber of an agency or organization who is capable Note:Tons,Metric Tons,Cubic Meters,and Cubic Yards should only be report in t
<br /> of and accepts responsibnitymfor proyiding dgtalled Information about the shlpmenli•,-_ connection with very large bulk shipments;such as rail cars;lank trucks;or barge•6. I
<br /> '2.Reach a phone[hat Is monit red 24 hours a day at allTmes the este Is In transp ortation
<br /> r Item 13,Waste Codes I
<br /> (including transportation related storage);and i ) I l I ,
<br /> ;3. ped and
<br /> Enter up to six federal and state waste codes to describe each waste stream iden Sed In'Iteral
<br /> Reach someone who is either knowledgeable of the hazardous waste being ship
<br /> has comprehensive emargericy response and spill clepnup/incident mitigation information --- 9b. State waste codes that are not redundant with federal codes must be entered here,rlri
<br /> for the material being shipped or has Irpmedlate access to a person who hat that knowledge addition to the federal waste codes which are most representative of the properUQs of the;
<br /> and information about the shipment, ! waste. ! ;
<br /> Note:Emergency Response Item 14.Special Handling Instructions and Additional Information
<br /> rg y p phone numoer informatlon should onlyi.be entered In Item 3 when I I ,
<br /> ;there is one phone number that applies fo all the waste materials described In Item 9b. Val—• 1:Generators may enter any special harldligg or shiPrggnt speeifc Ir)fortim n�Fasl�aiyfgr
<br /> (situation(e.g.,consolidated•shipments)arises where more than one Emergency Response the proper management or tracking of the metedals under the generetor's'or other t j !
<br /> ;phone number applies to the various wastes listed on the manifest,the phone numbers handlers business processes,such as waste profile numbers,container codes,bar codes,
<br /> associated with each specific material should be entered after its description In Item 9b. orresponse guide numbers. Generators also may use this space to enter additional! ;
<br /> Item 4.Manifest Tracking Number, descriptive Information their shipped materials,such as chemical names,consNent
<br /> orm tiaon about
<br /> .....
<br /> -• `r.b�•r. percentages;.phy�clahrtaleti o spe�ifc graytly.of wastes ldentified,with volumelunits in,
<br /> -This unlque traclong'humbermust'be;'Pw'printed ori°tire rrianife5t0`ylhe'doiriis�iYlter'
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<br /> un Miling"Aaldr'4"PdndlNY �r Is it t•:nrglatifnrla•./�.. >'.•d•x,rk,•r;•r,,h Ita(�,I2 d. ;r
<br /> it6mti.Gcnoraloi's a rnbernnd'SiteA�driiess '• ,-' .;, ar..rc:mom,m.lf..;. In.,:.:.,.:., ..•.rJsgdr•.i._,,:.r-; ..,:•>
<br /> +gym^F::•. •':Y: J1'2,:Thlsapacemaybe:Used;(procgrt)Ijmitgd.types,oftagerallylrequl(ed_InfbopatloPfor thhfc1j
<br /> Enter the name of the generator,the mailing.address:lo;whictlaha co.Rlpfe..ted"mapUestsigned n;bfr1.rn there;ls.no specific spadelprovided:an the manfestiiinciuding.any alternate.ficil[ty
<br /> by the deslgoated bglll(ly should be mailed;and the generators telephone number.'Notem,lha; designations;the man'Ifesftiacking numbs rof th;Qpmigi%it an(fest(orrgjected wasfas_arjd
<br /> telephone number(Including area code)should be the normal business number for the residues that are re-shipped under a second manifest;and the specl8caliegpi.PCB wlistil
<br /> +generator,or the number_whefe the generator or his authorized agent maybe reached to . -(- . descriptions and PCB out-of-service-dates-required.under40 CER 761.207..-.Generators,t
<br /> provide Instructions In the event the designated and/or alternate(if any)facility rejects somq o(n r . .hov(ever,cannot be required to enteyln(gffnall�Ir�this space tdi be(°stele`Ferjillato'ry I
<br /> all offfie efilpineri�Also enter the pbysfcal site address from which)kq shipraent originates requirements. (Int ;w c:udr awf,rw n rr.� s.;a,
<br /> only If this address Is different than the mailing address. lfein 15.Generafor's1014ror's Ceitlficallons;.; ` {{
<br /> item 6.Transporter I CompanyName,and U:S:EPA ID Number ',a.. :-- I.-The generator most"read,"sign,and date the W9§te:minjrttizapon gertjftoaligti.-p fnojlt:'In
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<br /> ,Enter the company name and U.S.EPA ID number of the first transpotter-who wil transport the/ signing the waste minimization certification statement,those generators who have not;i
<br /> waste.Vebide ox ddvenlnfofmallon may not be entered,here. been exempted by statute or regulation from the duty to rpake a waste minimintlon.i:'•.;
<br /> itimT"Tran :r.:•:" i,?
<br /> sjiditer 2 CbmpanyNome and U.S.EPA ID Number certification under section 3002(b)of RCRA are also cerUtyilig ih'at ttiiiytiaVe CordpFjAd':.
<br /> If applicable,enter the company name and U.S.EPA ID number of the second transporter who; with the waste minimization requirements.The Generators Certification also contalris the
<br /> l will transport the waste.Vehicle or driver Information may notbe entered'here.' -required attestation that the shipment has been properly prepared and Is-in prop r
<br /> If more than t(arisporters'are needed,us'e a Cor�tffivation Sheet(sf(EPA Fetm 8700-22A). condition for transportation(the shippers certification).The content oflh'e s P"pePs
<br /> r- ,�•i.•' cerllfigetlon statement is as follows:.;I;hereby�declare that the contentscfahis .16:;' ! ;
<br /> Item 8.D'estf h'X dackty Name,Slte AddiWsR,'andl).S.LPA ID Number "' consignment are fully and accurately described above by the proper shipping name,hrid'
<br /> j Enter the company name and site address of the facility designated to receive the waste listed are classified,packaged,marked and labeled/placarded,and are in all respects in proper
<br /> an this manifest. Also enter fhe•(acillfy'slphona Rurpbejr and the l):S.`EPA"iuVelve digit - -condition for transport according to applicable international,and national govemmentel.
<br /> I idenfification.numberof.the facility. °i regulations. If export shipment and I am the Primary Exporter',I`eerfily itiat the cdntents'of
<br /> Ildm 9.U.S.DOT Description(Including Proper Shipping Name,Hazard Class or Division, this consignment conform to the terms of the attached EPA Acknowledgment of Con$eht'
<br /> Identltkalion Number,and Packing Group) { When a party other than the generator prepares the shipment for Irensportalioriglhls'oady
<br /> may also sin the shippers certification stat ant•, the, r r of ;
<br /> Item 9a. If the wa5tea:identl6ed in Item 9b consist of both hazardous and nonhazardous -� 9 PP , carp., a� q(fp q,.,_•thesh�pplent.. . '
<br /> materials,then Identify the hazardous materials by entering an'X'in this Item next to the l 2. Generator or Offeror personnel may preprint the words,"On behalf of in the signature,
<br /> corresponding liazardous material Identified In Item 9b.. block or.mayhand write this statementin the signature.block prior to signing the . .'`..''.
<br /> 'Item 96.Enter the U.S.DOT.Proper Shlpping.Name,.Hazard Class or'Divlsion;'I'den611caUD{t: fw.lgenerator/offeF0rrcortillcatloh,(o')ndk�te that rte individual-signs as the employee dr:agent
<br /> I Number(UNINA)and Packing Group for each viesle as Identified In 49 CFR 172. Include of the named principal.
<br /> 1 technical name(s)and reportable quantity references,if applicable. Note: All of the above information excep#the handwritten signature required In Item 16'may
<br /> Note:if additional space IS needed forwasle descriptlons,enter,(gessadr(Itiorj@I-,d�§ellptlotrs �,Ple,,printeM,�l.. SFR:II t:Iai^•, t,:,;4 n;� mf.ryt... -qr-• • ::r"f 1:;,_r�__
<br /> in Its 27:on,the CpgUpuation Sheet(EPA Form 8700-22A).Also,If more than one-
<br /> 'Emergency
<br /> ne :_ :,: =" - ••• =•'
<br /> 'Emergency Response phone number applies to-the various wastes described!neither Item 9b, )
<br /> forAtem27,entelapplicableEmergencyResponse,phone numbers Immediately followingthe I ._. _•-._ . ,•_ M, _ _
<br /> •sh!pptr g descriptiops.for tt ose;lte s,. ' t r:,+ria• �x�:rroufi :zrrtic .r` { :�f -.>:r:Y' 'N;:r,r;7 a,;.
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