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I I,! , EPA Forro 8100,22 Note: If additional space is needed for waste desulpholIs o Ifer Mel e additiolrl doscopiions
<br /> Read all instnlCtions botore mrlpletruf this Joint. in Item 27 on [tie continuation sheet (EPA f ontl 8700-22A) Also if inow than one
<br /> 1. Federal regulations tequile geneiatois and Ianspodeis of hazardous waste and owners or Emergency Response phone nunnb,rr applies to the var ow wash, described m orfher Item
<br /> operators of receiving facilities designated on the manifest to complete this font (EPA Form 91)or item 27, enter applicA)le Emergency Rel;po Ise phone friribols inronedfalely following
<br /> 8700-22)and, if noeessaiy, the continuation sheet(EPA Foul 8700-22A) for bolts inter- the shipping descriptions for chose Itoms
<br /> and Intfaslato lranspokllion of hazardous waste- Item 10, Containeis (Nurifhet and Type)
<br /> 2. Thi;u manifest reflects iotolatdi rg changes made by U.:, 'EPA in Cry cernber 2017. Enter the nurnberof containers for each waste and the applopriele nbbrcvielion iron Table I
<br /> Beginning on Junes :10, 2018,this r,rarlitest (Revision 12.17) mum Iry used and ail (below) for the type of container
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<br /> pievioris editions are prohibited. t act to wa✓w cfaa.cfovlc-m nice<rt fm additinir ni TABLI I TYPES OF Cq_NiAINFRS
<br /> information. BA = Burlap, cloth, paper, or plastic bags. DT == Dump truck.
<br /> 3. This form must be purchased Prom a regf:;feted printer CF = Fiber or plastic boxes, cadre,,,, cases. DW =Wooden dnlms, tomf" , kegs.
<br /> (Mips//www.epa.govlhwgeneralots/approved-registered-printers-epacmanifesl- CM =Metal boxes, cations, cases(including roll- HG = Hopper or gondola cars-
<br /> flegistryfihow) and has been designed 10 be, filled out using standard computer printers, a 0Ifs).
<br /> Inn point pen may also he ur;ed—press down Hard. Aftor ;title 30, 201fl, this fort r can also GIN=Wooden boxes, cartons, rases. TC - Tank cars
<br /> be contpleded eleehonically In t PA r ivinnflesl system. CY = Cylinders. TP = Portable tanks.
<br /> The pub rc hrurf.or lr.dlr the Un hill l rd�xul'/ 1� fr In i.-:ai r cif : oved and CIAB 20.,0003J is ed no to a nra{ta ee, rInw fast)Ul 'i _ _
<br /> rnnul-for fienaalor Nrrnu!r nr ir3n=perder: ,ill}0mn:r4as hru,n. i. I DF = Fiber410drd or plastic dtuinr; barrels, kegs. f f = Cargo f8rli$ (tank IrrC(S).
<br /> d,e r tr fraeitngi c I d=sine redurfietl rid- 1 Ili"isa
<br /> nrandalayc:o$e ro rnJH40 CR Part 203,SrFupfrIU,111CRf,rt)rdSubr,ar1B . el nCPR Pah2t,4 end Zorn,Sue7d E An apem(at Cy not DM - Metal drums, bane,ls, kegs.
<br /> candwI or spew c mJar on I,PIA rrqu dfor fondro,ace ,I nu m'amral ❑unle, iidsp� yi a cuaCollyve d OMB control nL1,0K r.fh: Iteill 11. Total�itarltrty
<br /> r ump'eted lone shnddb u`.rral d n.cc, irxs trAh ih-u,feud n I 1"n,up.nyr toe form,or a.sp,,f:Ain lire con °f>nrrd r9 reguhIan Send Enter, In designated boxes, the total quantity y t uantif of waste. Round partial orals to (fie nod&lsl
<br /> camnrenls on lh A9 a/ ;nrerl(or tni.xrinmatfo� fr i < r.,cynlL pr rndad ire„4 nettnnales,owelnny eug}crhd manods Fonuimmtnprespondtgl I
<br /> whale unit, and do not enter decimals of fractions. To duo exient arnctical, leper'r uenilBas
<br /> rxn�w rot:Crdu<q thrmaw du:used rfel,toi},D ecf.e,Cdr! eiShrl qec L'u,on,US.En ,r nmerdal Prn!Fc`rot Aq,ury(2822o,I200 1 q
<br /> PennsyivaoIl Ate NVJ Vlasrdr,,I,n UL 20160_Pwas r iwk Vw G'7conbolmrr t rncny conmplldeoce.Do NOT s<rnd the completed manifest Using appropriate nnil9 of measure that will allow you to inpol quaillrlies with precision.
<br /> forms III this addn-s.FnvaryArl nt-Nuneulin., 'onmstor 'teedunda the Man`=,M.nuaariscons!JwrlPeiSo,,3hyldenff>fn Waste (JraiilitiesenfeledSheUldbe based Oil actual nleacifernentSofroesonablyaccuralo
<br /> IMomratmn IN)or C"iffW----a----- r a le,cur rrc r(t r�q --_ __ -3 estimates of acival quantities r shipped.lipped_ Container capac.ulos are not accepiabir, as estimaies.
<br /> I. tr,.rrrlar�tfrlrB t frrr CI nciators Item 12 Units ofMeasi-tie (Weight/Volume)
<br /> Itern 1. Genwalor's U,t;. EPA idenlific anion Number Enter, in designated boxes, the appropriate abbreviation from Table Il (below) for the unit of
<br /> Enter life generators U.S EPA twelve digit identification number, or the slate generator nieasure
<br /> identification numbrrr if the goioraiot silo des not have an EPA identification number TABLE II.--UNITS OF MEASURE
<br /> Itern 2. Pei/Ier I of G == Gallons(liquids only). N = Cubic Meters_
<br /> Enter the lofai mrniber of pages used to complete this manifest (i.e., the Ifsi pager (EPA Form K= Kilograms. P = Pounds.
<br /> 8700-22)plus tine number of conin r inkon ,,heels (FPA Form 8700-22A), if esny)- I- = Liters(liquids only). T - Tons (2000 Pounds).
<br /> Item 3. Vmerflency Response Phnue Number M =- Metric Tens (1000 kilograms). Y- Cubic Yards-
<br /> Enter a phone nunleer for winch emergonev respon o infofmalion can be obtained in the event Note I ons, Metre Tons, Cubic Wilms, and Cubic Yards should only be reported for vein
<br /> of an incident during limispoildh011_TIn;, elnelpHli y response phone PLIHMer must large bulk shipments, such as rail cars, tank hunks, or barges.
<br /> i. Be die number of Phu genemtorof iho numberred rn egency or olganvalion Who is Item 13 Wasto ("odes
<br /> capable of and rna:eels respons1106h/ for providing cualailed ulfomat on about the Enter up to six federal and state waste codes to describe each waste stream idoniified in Item
<br /> shipment, 9b. State wasle codes that are not redundant with federal codes must be entered here, in
<br /> 2. Reach a phone that ie monitored 24 hours a day at all fines the waste is in Ganspodahon addition to the federal waste codes which are most representative of the piopoaiies of the
<br /> (including transpolialion related storage), and waste.
<br /> 3. Reach r;omeone who is either knovviecigeahle of the ha7_aidon5 waste being shipped and floor, Iv! Special Naudiiw fi sfrilchons and M( ftionril infoinwhoo
<br /> has comprehensive ernefgency response and spill cleanup/incident fmtigalion nlfomlation 1 Generator,may enter any special handling or shipmhni specific miol nailol necossanl
<br /> for the materiel being shipped or has winedrale access to a person who has that knowledge for the proper inenagenient or backing of the materials tinder Inc genorakn or other
<br /> anti inform-Jion about the shipinerril handler's business processes such as waste profile nunibais contililrol rode:;, liar
<br /> Note: Emergency Response phone number information should only be entered in hem 3 when codes, of response guide numbers Gene ialois also miry use fluv space to ranter
<br /> there is one phone nurnber that applies to all the vtaste materials described irk Item 91. If a additional descriptive lnformalion about their chipped nlah:liN such ins rietiicai
<br /> situation (e.g , consolidaled :hiprnents) inn;es wi ere more than one Fineigency Response name, , constitur of x rrenlac , , physical Pate, or r lecihe c ti grit of lml,tc aft nfillcri
<br /> s a fa : , J ` t l s ' t Jn Y , �s
<br /> phone numhcr apprOS to fife vanous wales listed oil the marufesl, life phone numbers with volume units In Item 12,
<br /> associated with each specific material should be eirieied after its description in Item 91)
<br /> Item 4. Manifest 1 rrclanr�llaurrlbr-ir 2 This spare may bo used to record iirluferi Lyle;of fr deraliy re,>qurrnrt nrfofirr�tlon for which
<br /> mere is no specific spare provided on the uranrloM, Incuding any aliornrlie iririlily
<br /> This unique backing fit muct be pie printed on the manifest by the forms prinfel designations; fife manifest tracking number of the or!3inai inandosf for rejf,c Jed ewastes
<br /> Ifenl 6 Gerleraioi's Maihirg Address, Phourr A.harlbr/i Ind `>ife Aordiess and residues Thal are re-sIlipped tender a eecond m<uufe ;i, and the cpouil ntfon of
<br /> Enter Ihr nano of file generator, the Inading address to which the completed manifest signed polychlonnatecl biphenyl (PCB)waste dosrnptions and PCB out of service dalos o,gtjflCd
<br /> by the designated laulfiy should be mailed, and tho generatoi's telephone number Note, the under 40 CFR 761.2O7 Generators, however, cannot be requited to eniei miounalon for
<br /> telephone number (Including afra code) should be the nannal business number for the this space to meet stafo regulaloiy requirements
<br /> generatof or the nunllml ,vhero the gcnelaloi or hi r rluihofized agent inay be reached to Item 16. Caerierlio'a Ofleroi's Cer'fikcations
<br /> provide inshuclions in the evemi life, desigraler and/or alternate (if any) facility ieiecis some of I The generator'r.nerator trust rf ad i(n and date the waste mi nunizalion t e i lific iffon s(a,.rncni In
<br /> a all of trip, hiprnenI Al:,n ente,i the physic I site adrl m ess fro which file shipment originates
<br /> sighing the waste mrnnuzalion certihcation slatenlenf 1hr ,e generators who he,rvr�. not
<br /> only if this address i`t drfre ient than the mailnq addle, �s. been exempted by slaiute or regulation front lire duty bl hake a WIstO muartlralion
<br /> Item 6. Ti awq)orroi I Company Mime, and U S. EPA ID Number certification under section 30t12(b) of RCRA are also reifying that liiey have complied
<br /> Enter the company name and U,1 . EPA ID number of the [list hanspoder who will transpori the with rho waste minimization requirements. The Generators Ge' h6cafion. iso contains the
<br /> waste. Vehicle of driver infonmallon may not be eldeted here, required atteste[loa that the shipment has both propotly prepered and i,; in proper
<br /> Itern 7. Transpo et 2 Company Name and 0 fin F1'A 11) Number condition for transporialion(the shipper's coriiiication). The tomtit of liar °lupfx�.r's
<br /> If applicable, enter the company name and U.S. EPA ID number of the second tianspodor certification statement is as follows: °I hereby declafc alai ifrn conients of this
<br /> who will transport the wasle. Vehicle or driver fnfonnalion may not be entered here. consignment are fully and accurately described above by the piop:fi chipping came,and
<br /> If more than two transporlers Ife needed, use a continuation sheei(s)(EPA Fomn 8700-22A) aro classified, packaged, tnalked and labeledlplacalded, and of a fit Al wspecfs in proper
<br /> item 8. ovsignated Facility Narno Site Ad,liess, and U.S. EPA ID Number condition for Pansport according to applicable intenlalionrnl and nillionai govemrnental
<br /> Enter the company name anti site address of fife facility designated to receive the waste listed regulations. If expos shipment and I am Ihe, Primary Lxporiei, I certify that the coafets of
<br /> on this manifest-Also enter the facility's phone number and the U.S. EPA twelve digitthis consignment conform to the lorms of the attached EPA Ackiev.1 rigtteni of Consent "
<br /> Identification number of the incilry. When a party other than the generator picpares the shymneni for iransporiation, fhis party
<br /> Itern 9. U.S DOT Oesrnpiloo (Including Mopei Shipping Namo, llazaid Class or Division, may also sign the shipper's certification statoment as the offeror of the shipment
<br /> Identification Number, and Packing Gioup) 2. Generator or Offeror personnel nnay prepnnf the words, "On behall of in lie -ignehure
<br /> Item 9a. If the wastes identified in Item 9b consist of both hazardous and nonhazardous block or may hand wrile this statement in the signature block pilot to siginng the
<br /> materials, then identify the hazardous malenals by enfedng an 'X, in this Vern next to the generator/offeror cedihcation, to ini ic:ale that the individual sign; as the employee of
<br /> corresponding hazardous malenai identified in item 9b agent of the named principal.
<br /> liern 91). Enter the U S DOT Proper Shipping Name i Inz and Class or Division, Met tifcalion Note: All of the above information except the handssiifton sfgnalufe required in Item Ib tilay be
<br /> Numhei (UN/NA) and Packing Group for each w"Isle as identified in 49 CFR part '172. Include pre-printed_(Handwritten signa(ures ate not applicable if the rteneralor is ptepaung and signing
<br /> technical names)and reportable quantify references, if appiicable. an elec(ronic manifest using EPA's e-Manifest system.)
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