|
U.S. EPA Forma 8700-22 Note: If tadditional 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 [fie various wastes described in either llem
<br /> operators of receiving facilities designated on the manifest to complete this total (EPA Form 91)or Item 27, enter applicable Emergency Response phone nurnbors 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(Nuttier 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, 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 (.--TYPES OF CONTAINERS
<br /> information. BA= Burlap, cloth, paper, or plasags- D7 =� Dump huck-
<br /> tio b
<br /> 3. This form must be purchased from a registered printer OF = Fiber or plastic boxes, callous, cases. DW = Wooden drums, barrels, kegs.
<br /> (ht4)s://www.epa.gov/hwgenerators/approved-registered-printers-(,pas-manifest- CM =Metal boxes, cartons, cases(including roll- FIG = Hopper or gondola cars.
<br /> registryi#how) 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. TO = Tank cars.
<br /> be completed electronically in EPA's e Manifest system. _ _ CY=Cylinders.Y TP= Portable tanks.
<br /> The pubrc burden related to the Uniifonn Hazardous Waste Manifest Mild,is apfxeed under 0?482500039 isestimated to aveiaga(osraw ifasli 60 r DF =Fiberboard Or plastic drinimS, barrels, kegs. TT Cargo lanky(tank trucks)..Nnutes for generators;20 nminutes for transpoders and 30 nsinutesfor a-,n_rseml ap iefors of rcaeiv rO fhatities desi{fnatedon tore manifest This isa
<br /> mandatorycallf.edrn under 40 GFR Port 282,Suboad 0,40 CFR Pad 263,Subpad,B mud 40 CFR Parts 264 and 265,Subpart E.An agency may not DM -Metal drums, barrels, kegs.
<br /> carMucl of sponsor,anti a poison is not requ edtore<pondia,acorleclbnof infw aid ton unless it rksp!ays a run enryvalid CiN control number.The Item 1/. Total Orntrfy
<br /> completed far n sherd be suNdattro,la�cordanee valor the ir�fn,das aerom,>atd;aig the form,masstexap.d In tile rag rEquIrt6an.Send Enter, m designated boxes, the total quantity of waste. Round partial units to the nearest
<br /> comments on the Agency's need far this information the,aviary of the pra,dell burden eshrnetes,and an/sudlte5tEd methods for min mating respondent
<br /> burden,indudu<ftUnoughtlto use,vfe-Al surfed,to the Model,Gorac heir SbateytiesDrvls'an,U.SEnviranmm,talProtecttonAye7icy(2&227f,120o whole unit, and do not enter decimals or fractions. To the extent tactical, report quantities
<br /> Pennsytrania Ave..NW,VPa_thington,0.420460.Please include the OtIB control number in any correspondence.Do NOT send the completed manifost Using appropriate, fruits of treasure that will allow you to report quantities with precision.
<br /> forms to this address.Privacy Act Statement-Ploneoftheoformation cotadod under the MaMtest Prof7rom is considered Persona'ly ldrfabab'e Waste quantities entered should be based on actual measurements or reasonably accurate
<br /> Inr«nan rPnrerconhdencafam mea3inra,nr, n(csl). _ __ _ -- _------- __ estimates of actual quantities shipped. Container capacities are not acceptable as estimates.
<br /> I. Instructions for Generators Item 12. Units of Measure (WeighWortarne)
<br /> Item 1. Generators U.S. EPA Identification Number Enter, in designated boxes, the appropriate abbreviation from Table II (below) for the unit of
<br /> Enter the generator's U.S. EPA twelve-digit identification number, or the stale generator measure,
<br /> identification number if the generator site does not have an EPA identification number. TABLE IL--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 Foma 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 />(tern 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
<br /> Enter up to six federal and state waste codes to describe each waste stream identified in Item
<br /> shipment; 9b. State waste codes ihal are not redundant with federal codes must he 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 odes 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 4 g 9 pP (tern 1 ? Special rl4andling Instruci'ions and Additional Intorrriation
<br /> has comprehensive emergency response and spill cleanupAncident mitigation information 1 Generators naay enter any special handling or shipment-specific information necessary
<br /> for the material being shipped or has i nmediate access to a person who has that knowledge for the proper management or tracking of the materials under the generator's or other
<br /> and information about lire shipment, handler's business processes, ,a c:h as waste profile nurnbers, 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 [his space to enter
<br /> there is one phone number that applies to all the waste materials described in Item 9b. If a additional doscriptive information about their shipped materials, such as chemical
<br /> situation (e.g., consolidated shipments) arises where more than one Emergency Response names, con:;lituenl percentages, physical state, or specific gravity of wastes identified
<br /> number applies to tine various wastes listed on tale manifest,the phone numbers associated with each specific material should be entered after its description in Item 9b. with volume units in item 12.
<br />'tern 4. Manifest Tracking Number 2 This space may be used to record liolited types o[federally required information for which
<br /> there is no Specific space provided on the manifest, including any alternate facility
<br /> This unique tracking number muss be preprinted on the manifest by the Tomas printer. designations, line manifest tracking number of the original manifest for rejected wastes
<br />'tom 5. Generators Mailing Address, Phone Number and Site Address and residues ilaat are re-shipped under a second manifest, and the specification of
<br /> Enter the name of tine generator, the mailing address to which the completed manifest signed polychloiinaled biphenyl (PCB) waste descriptions and PCB out-of-service dates required
<br /> by the designated tactility should be mailed, and the generator's telephone number. Note, Ilia under 40 CFR 70'1207 Generators, however, cannot be required to enter infounation in
<br /> telephone number(including area code) should be the normal business number for rho this space [o meet state regulatory requirements.
<br /> generator, or k9Te number where the generator or his authorized agent may be reached to item M Genetator'rlOfteror's Cetiifications
<br /> provide instructions in the event the designated and/oraltemate (if any)facility rejects some or 1- e generator must read, sign, and dale the waste minimization certification statement In
<br /> all of the shipment. Also enter the physical site address from which the shipment originates (ire
<br /> the waste minnniz nt on certific miler statement, those generators who have not
<br /> only if this address is different than the mailing address. been exernpled by stahiie or regulation from the duty to make a waste minimization
<br /> tern G. Transporter 1 Company Name, and U.S. EPA ID Number codification under section 3002(b) of RCRA are also ce trying that they have complied
<br /> the company name and U.S EPA ID number of the best transporter who will transport the with the waste mininnzation requirements. The Generator's Certification also contains the
<br /> waste.Vehicle or driver information may not be entered here. required al[estation that the shipment has been property prepared and is in proper
<br /> rem 7. Transporter 2 Company Name and U.S. EPA 1D Number condition for transportation (the shippol'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: 1 hereby declare that life contents of this
<br /> who will transport the waste. Vehicle or driver information may not be entered here consignment are fully and accurately doscnbed above by the proper shipping name,and
<br /> If more than two transporters are needed, use s continuation sheet(s)(EPA Form 8700-22A), are classified, packaged, marked and labeled/placarded, and are in all respects in proper
<br /> fem 8. Designated Facility Name, Site Address, and U_S. EPA ID Number condition tot 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 Expoder, I certify that tine contents of
<br /> on this manifest. Also enter the facility's phone number and the US. EPA twelve-digit this consignment conform to the leans of the allached EPA Acknowledgment of Consent"
<br /> Identification number of the facility_ When a party other than the generator prepares the shipment tot transportat on, this party
<br />'am R U.S- DOT Description (Including Proper Shipping Name, Hazard Class or Division, may also slgn the shipper's codification s(alonnent as the offeror of the shipment
<br /> Jentification Number, and Packing Group) 2. Generator or Offeroi personnel may proprint the words, `On behalf of° in the signahare
<br /> Item ga. If the wastes identified in Item 9b consist of both hazardous and nonhazardous block or may hand write this stalemerll in the signature black prior to signing ilia
<br /> materials, then identify the hazardous matenals by entering an "X" in this Item next to the generator/offeror certification, to indicate that the individual signs as the employee or
<br /> corresponding hazardous matailal identified in Item Jb. agent ofthe nbmotl principal,
<br /> Item 9b. Enter the U.S. DOT Proper Shipping Narne, Hazard Class or Division, Identification Note: All of the above information except the handw!itten 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-piinted. (Flandwfitten signatures are not applicable if the generator is preparing and signing
<br /> technical narne(s) and reportable quantity references, if applicable. an electronic manifest using EPA's o-Manifest systern.) i
<br /> i
<br /> I
<br /> i
<br /> m
<br /> i
<br /> f
<br />
|