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U.S. EPA Fonn 8700-22 Note: If additional space is needed for waste descriptions, onler these additional descriptions
<br /> Read all instructions before completing this form. ire Item 27 on the continuation sheet(EPA Fortin 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 on the manifest to complete this form (EPA Form 9b or Item 21, enter applicable Emergency Response phono numbers immediately following
<br /> 870(f-22)and, if necessary, the confirmation 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 Table I
<br /> Beginning on June 30, 201 this manifest (Revision 12-17) must be used and all (below) for the type of container,
<br /> previous editions are prohibited. Go to wt�v.epa.govle-manifest for additional 1 ABLE 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 /> (I)fps://www.epa.gov/hwgeneralors/approved-registered-printers-epos-manifest- CPA = Metal boxes, cartons, cases (including roll- HG = Hopper or gondola cars
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<br /> registrylthow) 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, carious, cases. TC =Tank cars.
<br /> p CY Cylinders. TP = Portable tanks.
<br /> e completed electronically in EPA's e Manifest system.
<br /> The ubllcburrimfelat.,dtotheUntomrHazaidm,Wo e,Mzrti4esl vin hr approvedund rOMB205f 0069,ise4roaledtoaverzgeQwrmar,fas-t)60 DF — Fiberboard or plastic drums, barrels, kegs. TT = Cargo links (tank if ticks),
<br /> minutes for generators;20 ntinU!ee for haroporiers and 60 nisabs for o n rsendMr rnlorso recervie7 far,,ties deslgneted on rt>,:nran lrsl This lsa
<br /> marselorycorecifrm under 40 CFR Part 262,Subpart 6,40 CFR Pad 265 Subpar)D,nnd 40 CFR Parts 264 and 265,Subpart E Anagencymaynet DM —Metal dmn'is, barrels, kegs,
<br /> conduct oisponsor,and a person is not requited to respond to.aco'Ic.lionofWmmatlaourr!essrtHapleysa currently veld 0^„i0 conlrN number.The Item 11. Total Coal,ilily
<br /> carp,@ted rotor should be eubmdr din accoidsacenwfh the instructions acrompsn)urg tire fume,or as spec Red in the cot,espondrnp regurat air Send the art Enter, In designated boxes, the fetal quantity Of W2S1P.. Round idrai mints t0 the nearest
<br /> buncommenLv on 64e Ay.ncy's need for Eris infomaatian curacy of the provided burden estimates,and any suggested methods for m»mmng res{xxn9ent p
<br /> n,including m h the use of e-Manif&M,to the Director,cete strale�esDes us En nnrn�,aiPmte,,er,A?erKYfz6zz),1200 whole unit, and do not enter decimals or fractions To the extent practical, report quantities
<br /> Pennsyrvarsa Ave.,NW,Waehlnoton,DO 20460.Please indude the OAlB control nurnher in anycorre.pondeace.Do NOT send the cornpletgd m,nnlfeM rising appropriate nulls of measure that will allow you to report quantities with precision.
<br /> rotors to this address.Prracy Ad Sinternml-None(fthe irformatron mtr6r3ad under fire Manifest Pmgrarri iscernslderadPersonallyldentdia4'e Waste quantities entered should be based On actual meaSUremeniS of Basonabiy accurate,
<br /> tet�nrPniorconfidannafeutvrassmfom ronrC9ir. estimates of actual quantities shipped. Container capacities are not acceptable as estimates.
<br /> I. We
<br /> Item 1. Generators U.S. EPA Identification
<br /> for Generators Item 12. Units of Measure ( i17h P/Volume)
<br /> Ins
<br /> ation Number Enter, in designated boxes the apptopriate abbreviation from Table II (below) for the unit of
<br /> Enter tine generator's U.S. EPA twelve-digit identification number, or the slate generator measure,
<br /> identification number if the generator site does not have an EPA identification number. TABLE IL--UNITS OF MEASURE
<br /> Ifem 2. Page I of_ G = Gallons(liquids only). N =Cubic Meters.
<br /> Enter lire total numbed of pages used to complete this manifest (i.e., Use first page (EPA Fora K = Kilograms. P = Pounds
<br /> 8700-22)plus the number of continuation shoets (EPA Form 8700-22A), if any). L= Lifers (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 infonnalion can be obtained in the event Note: Toils, 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 shiprrlenis, such as rail czars, tank trucks, or barges
<br /> 1. Be the number of the generated or the number of an agency or organization who is Item 13. Wasted Codes
<br /> capable of and accepts responsibility for providing detailed information about the Enter up to six faderal and stale waste codes to describe each waste sheara 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 hansportation addition to the federal waste codes which are most representative of die 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 I landling instnu,ttoo, and Additional information
<br /> has comprehensive ereigency response and spill cleanup/incident nuhgafion information
<br /> 1. Venerators may enter any special handling of shipment-specific uafodrnation necessary
<br /> for the material being shipped or has immediate access to a person who has that knowledge for the proper management or hacking of tho materials under generator's
<br /> or other
<br /> and information about the shipment handler's business piocesses, such as waste profile numbers, container codes, bar
<br /> Note: Emergency Response phone number information should only be entered in Hem 3 when codes, or response guide numbers. Generators also tiny use this space to enter
<br /> there is one phone number Ihal applies to all Hie waste materials described in item 9b. If a additional descriptive infomtalion about their shipped materials, such as chemical
<br /> situation (e g, consohdaled shipments) apses where more than one Emergency Response phone number applies to Hie various wastes listed on the manifest, the phone numbers names, constituent percentages, physical stale, or specific gravity of wastes identified
<br /> associated
<br /> with
<br /> each specific
<br /> pecific material should be. entered after its description in Ifem 9b with volume units in item 12
<br /> tee 4 at
<br /> J nber 2. This space may be used to record limited types of federally required information for which
<br /> U7cre is no specific space provided on the manifest, including any alternate facility
<br /> This unique tracking number must be pre pr uteri our the manifest by the forms printer. dosignations, the manifest Iracking numbei of the original manifest for rejected wastes
<br /> tern 5. Generators Mailing Address, Phone Numberand Site Address and residtuu th,ri ole, rG-shiirpec3 uncial a second manifest; and the specification of
<br /> Enter the name of the generator, the snarling address to which )lie completed manifest signed polychior nnfed biphenyl (PCB) waste descriptions and PCB out oi-ser M dales requited
<br /> by the designated facility should be mailed, and the generator's telephone numbed.Note, the under 40 CFR 76'L207 Generators, however, cannot be required to enter infounition in
<br /> telephone number(including area code) should be the normal business number for the [his space to meet stale legulalory requirennenls
<br /> generator, or the numborwhete the generator or his authorized agent may be reached to Item 15 Cedillcairons
<br /> provide instructions in the event the designated and/or ademate (if any) facility rejects some, or
<br /> all of the shipment_Also enter life physical site address from which the shipment originates i. The generator must road sign, and date iht ',Vast(-., minimization certification statement in
<br /> only it this address is different than the mailing address. signing the waste minunizahon certification stitcvnert, lnose generators who have viol
<br /> rem 6. Transporter I Company Narne, and U.S. EPA ID Number been exempted by Jhdtrte or regulation from the duty to make a waste minimization
<br /> certification under section 3002(b) of RCRA are also certifying that they have complied
<br /> Enter Hie company name and U.S. EPA ID number of the first transporter who will transport the with tile waste minimization requirements. The Generator's Certification also contains file
<br /> waste.Vehicle or driver information may riot be entered here. required ailestafio i that file shipment has been properly prepared and is in proper
<br />'em 7. Transporter 2 Company Narne and U.S. EPA ID Number condition for Ifansportalloll (file shipper's 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 drier information may not be entered here consignment are Cully 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, packagod, minted and labeled/placarded, and ode in all respects in proper
<br /> ern E. Designated Facility Name, Site Address, and U.S EPA ID Number condition foi transport accodding to applicable international and national governmental
<br /> Enter die 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 facifity's phone number and the U.S. EPA twelve-digit this consignment conform to the terms of fife attached EPA Acknowledgment of Consent"
<br /> identification number of the facility. Whom a party other than the generator prepades Ille shipment for rfi'anspodal on, this party
<br /> em 9_ U.S_ DOT Description (Including Proper Shipping Name, Hazard Class or Division, may also sign the shipper's certification statement as the offeror of the shipment.
<br /> ienlifiration Number, and Packing Group) 2 Generator or Offerol personnel may preprint the words, "On behalf of in tine signature
<br /> Item 9a. If the wastes identified in Item 9b consist of both hazardous and nonhazardous block or may hand write this statement it the signature block prior to signing the
<br /> materials, then identify the hazardous materials by entering an "X"in this Item next to the generatodofferor certification, to indicate that the individual signs as the employee or
<br /> corresponding hazardous matenal identified in Item 9b. agent of the named principal.
<br /> Item 9b. Enter the U.S. DOT Proper Shipping Narne, Hac&qnrd Class or Division, Identification Note: All or the above information except the handwritten signature required in Item 15 may be
<br /> Number(UNINA) and Packing Group for each waste as identified in 49 CFR part 172. Include pre-printed. (Handwritten signatures are not applicable if the genefaloi is preparing and signing
<br /> technical ri tne(s) and reportable quantity references, it applicable, an electmnic manifest using EPA's e-Manifest system )
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