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U.S. EPA Form 8700-22 Note: If additional space is needed for waste descriptions, enter These additional descriptions
<br /> in Item 27 on the continuation sheet EPA Form 8700-22A . Also, if more than one
<br />,ead all instructions before completing this form ( )
<br /> t- 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 91)or Item 27 enter applicable Emergency Response phone numbers immediately following
<br /> 8700-22)and, if necessary, the confirmation sheet (EPA Form 8700-22A)for both inter- tlme shipping descriptions far these 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, 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 /> (hops://www.epa.govihwgenerators/approved-registered-printers-epas-manifest- CM =Metal boxes, cartons, cases (including roll- FIG = Hopper or gondola cars.
<br /> registry 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. TC =Tank cars.
<br /> be completed electronically in EPA's (,,-Manifest system. CY = Cylinders. TP = Portable ranks.
<br /> Tha public burdsn related to the Unifomr Nacardoa,rs Waste Manifest,•drlch is approved under Oh78 2050 0039,is esfmated to average Or manifest)00
<br /> Oautes for generaim,20 riinnte3rao-anspndery,and aonxnn,e,for e,nem�dnp�ratn�nrreceivinpfacrf,use slgnateaenu ��srThisisa DF = Fiberboard or plastic dmrns, barrels, kegs. TT = Cargo tanks (tank tucks).
<br /> mandalorycuf7acYian under40 CFR Par TQ,SA*ddB,40GFR Part 263,Subpart B,and40CFR Pads264 and 265,Srtbpad E A.nagencynraynol DM =Metal drums, barrels, kegs.
<br /> conduct or sponsor,and a person is net required to respond In acoroctan ohnturmatioa unless it displays a currcNly va.d MID contrei numt;er.Ttre I Item 11. Total Quantity
<br /> com(areted loan shoord be suborned m acmrdonre with the m instmdiouacro o;xanyxt9 the fern,or as sperrfrad in[fie wrrespondng Orydabon-Send Erler, In designated boxes, the total quar1fily Of Waste. Round partial Unit9 t0 the nearest
<br /> cotnenG on the Agenc)✓s tired for this infonoahrm the acmrary of the po.rded burden estirraras,and any su9gesled methods for minirnircg respondent
<br /> burtfen,indudng throrngh trio use ore PhanN�l,to the Drr<dor,CWlxGan Stra!=gke Drws,gn,U.S.EnVronncetifalPmtecbm Agency(2822T).1200 whole unit, and no not enter decimals or fractions. To the extent practical, report quantities
<br /> PennsyAvano Ave.,NW,WwNrigion,O.C.2M60.Please include tine MID control numher in any correspondence.Do NOT send the.Completed manitnst using appropriate finds of meaSUre that will allow you to report quantities with precision.
<br /> Ions to tills address.Privacy Act Statement-None or the rrdannation cc!lec"fm umier the Man*v" ,t Program is coils i erred Personally ldenlKvaMe Waste quantities entered should be based off actual measurements or reasonably aCCLIMIO
<br /> Inramatron(P)d or cooedenkalflne„e slnAr<,n,,,rlen(cep. _ _,-, _ estimates of actual quantifies shipped. Container capacities are not acceptable as estimates.
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<br /> 1. Instructions for generators Item 12. Units of Measure (Weight/Volume)
<br /> rem 1. Generator's U.S. EPA Identification Number Enter, in designated boxes, the appropriate abbreviation ftem Table II (below)for the unit of
<br /> Enter the generator's U-S. EPA twelve-digil identification number, or the state generator measure,
<br /> identification number if the generator site does not have an EPA identification numher TABLE II.--UNITS OF MEASURE
<br /> tem 2. Page I 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 confinuaton sheets (EPA Form 8700-22A), if any). L = Lifers (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 to the event Note_Tons, Metric Tons, Cubic Meters, and Cubic Yards should only be reported for very
<br /> of an incident during if ansportation.The emergency response phone number must large bulk shipments, such as rail cars, tank trucks, or barges.
<br /> 1. Be the number of the genoraloi 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 wasie codes to describe each waste stream identified in Item
<br /> shipment, 9b. Stale 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 ttorn 14. Special ilaruliing tn,;tnlctious and Additional Intorrrration
<br /> has comprehensive emergency response and spilt cleanupfmcident mitigation information i. Generator,,; way erilcr ,my special handling or siiiprmenl-specific u3formtalion 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 materuits under the generator's or other
<br /> and information about the shipment. handler's 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 /> (here is one phone number that applies to all the waste materials described in Item 9b. If a additional descriptive infomation 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, of 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 /> p 2. Thies,space may be used to fecold loomed typos of fedr,rali required information for which
<br />'tem 4. Manifest Tiarkiug Number there is no specific spate 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 mandesl lwcki ig number of [he original manifest for rejected wastes {
<br />'rem 5. Generator's Mailing Address, Phone Number and Site Address and residues [bar are to shipped under a second manfesl, and the specification of I
<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 generator's telephone number. Note, the under 40 CFR 761 207 Generators, however, Cannot be, required to enter infollWAM it
<br /> telephone number(including area code) should be the normal business number for the this space to meet state regulatory tequiremenis-
<br /> generator, or the number where the generator or his authorized agent may be reached to qem iG Generatot slOfferol's Certifications
<br /> provide instructions in the event die designated and/or alternate (if any)facility rejects some or I The genemloi must readl sign, and elate the waste mmirriznlion c eiiiticatum statement In
<br /> all of the shipment Also enter lire physical silo address from which the shipment originates signing lire waste minimization certification statement, lhus"')generators who have not i
<br /> only if this address is different than the marling address. been exenipted by stniure or regulation from the duly to make a waste Ininunization
<br /> rtern 6. Transporler I Company Narne, and I LS. EPA ID Number cellificatiOul 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 file with the waste minirnwilion 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 property prepared and is um proper
<br /> Item 7. Transporter 2 Company Name and U.S. EPA ID Number condition for lrarsportalion (the slipper's certification).The content of the shipper a
<br /> If applicable, enter the company name and U S EPA ID number of the second transporter car lilicatilnf slarcinelil is c-ls follows_ "I hereby declare that the contents of this
<br /> who will transport the waste. Vehicle or driver information may not be entered here. t onsrgnrneni are fully and accut:fiely described above bV the proper shipping name, ;rind
<br /> If more than two transporters are needed, use a continuation shoot(s)(EPA Fcnm 8700-22A) ale daesllred, pactcait-, nlertceri and labelodlplacarded, and are in all ;e p�cls in proper
<br /> Item 8. Designated Facility blame, Site Address, and U.S EPA ID Number condition lot Irimpor I according to applicable iniemational and national govern willal j
<br /> Enter the company name and site address of the facility designated to receive the waste listed tegulatons. If export shipment and i am the Ptimaly Lxpoder, I certify that the contents of
<br /> on [his manifest.Also enter the facility's phone number and the U.S, EPA twelve-digit iht consupinieni confoun to life learns of fin aiiachod EPA Acknowledtairf;tid of Consent
<br /> identification number of the facility. Wh_In party oilier than the gcnef atom prepares the shipmeni for h inspoi ration, this party
<br /> Item 9 U S. DOT Description (including Proper Shipping Name, Naza(rl Class or Division, pray also sign the sirppc cemflca6orr statemcxlr as Tire offeror of the sfupnicrll
<br /> Identification Number, and Packing Group) 2 Generator or O[reroi personnel may preprini [he words, "On behalf oP in thca.,igrrature
<br /> Item 9a. If the wastes identified fit Item 9b consist of both hazardous and nonhazardous block or inay hard trite Phis stateritent in fire signature block poor to signing Tire
<br /> materials, then identify the hazardous materials by entering an 'X' in this Item next to the generalorlo(ferorcelh6ration, to indicate That the individual signs as the employee or
<br /> corresponding hazardous material identified in Item 9b agent of the named puncipai
<br /> Item 9b. Enter ktre Ll 5 DOT Promen Shipping Name, Hazard Class or Division, Identification Note: All of the above information except [he handwritten signature icquited in Item 15 may he
<br /> [ Pf J pr;opinitert_(Handwritten signatures are not applicable if fie generaoot Is preparing and signing €
<br /> Nurriber(UN/NA) and Paekfng Group for each waste as identified in 49 CFR part 172. include
<br /> technical name(s) and reportable quantity references, if applicable. an electronic manifest using EPA's r�Manifost sysrern-)
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