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U.S. EPA Fonm 8700 22. Note: If additional space is needed for waste descripi om, enter these additional riescnplions
<br /> lead all instructions belore completing this Iona. in Item 27 on fire continuation sheet(I-PA Form 8700-21A) Atr o, if more than one
<br /> 1. Federal regulations require generators and transporters of hazardous waste and owners or Emergency Response phone nurebet applies to tide varOLIS.wasles described in (,filter Item
<br /> operators of receiving facilities designated on the manifest to complete this form (EPA Form 9i or Item 27, eu(oi apple-ibis Emergency Response phono nunataers imniediafely following
<br /> 8700-22) and, if necessary, the continuation sheet(EPA Fort 8700-22A)for both inter- Itte Shipping descupiions lot ihosr Items.
<br /> and intrastate transpotation of hazardous waste. Item 10. Containers (Number and Type)
<br /> 2_ This manifest reflects fonroatting changes made by U.S. EPA in December 2017. Enterlhe number of coulainors lot c ach wasie and the appropriate abbreviaton from Table I
<br /> Beginning on June 10, 2018, this manifest (Revision 12-17) must be used and all (below) for the type of container
<br /> previous editions are prohibited. tic,to www.epa.gyovle-manifest for additional I A01.E I _TYPIc OF CON i AINFR_
<br /> information. BA = Burlap, cloth, pallor, of piaslic,bags. DT Dump tuck.
<br /> 3. This form mfist be purchased front a registered printer CF == FibeI of plastic mixes, cation 4, cases_ DW = Wooden dtums, bancls, kegs.
<br /> (Ifttps1/www.epa.gov/hwgeneraloislapproved-registored-punters-epas-manifest- CM - Metal boxe , cations, rases (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 /> hmt point pen may also be used—press down hard. After June 30, 2018, this form can also GW - Wooden boxes, cations, r a ss. TC == Tank cars
<br /> be completed electonically in EPA's (,_Manifest system. Cy =Cylinder& TP = Pori; bie tanks
<br /> The parick hunhvn mlat-d lathe Unfwm karardousl Ja, Pantfe=1,tinrh ,apxnv,lunder MID 20500039,1s estimated to average,(per ma:ir6sr 65 '
<br /> OF = Fibeiioaid or pl lsitc dorms, barrels, hogs. Tl = Cargo Tanks (tank trucks).
<br /> rnmutes rot yene2lars 20 rmro;r-.Ina tmr+.'poder;und 30 nnntrizs form n r-r and operators n(receiv;n9 ienl tws designated on llw roan lest ills isa
<br /> manda"cc!!rd,cnund r4UCFR Pal 2rn,SubpartD,40CR4 Part 263 Subpad8,and400FRParis284 and 255,Subpart E.Air agency may(lot DM Metal drums, barrel,, kegs.
<br /> conduct or sponsor,and a person is not requ0-cvl to r ,pualto.acoae.Pciofor Format,url unless%d.splay'sa cup'entiyvarl0,r",B control rHhmrwc The tt@m 11. Total O(laj)tf
<br /> completed Iona shoed besubo,Jlcd in accordance Kth the mstmd^on .cron1r,"tug hoe fund,of as sp�,fi=d in the cane porsinjaga forlSend I- , r �c
<br /> F-ritm, in designaed boxes, the total quantity of waste. Round partial units to the nearest
<br /> commentson rite Aganc,sneedforbuuaEwmafion hl..ncc?racy of the pwnrWd bualene5hmates.andu,sub}e'!edm..ttrod,forvu6n'mzngre�^panctent �
<br /> harden,tndudag through the use rfe5aofesl,to the Diec:or,Co`laclmn Straregie5 D:vas+on,U.S.EnvxonmonlalPmterlmrr Ayencyt2t122T),1200 whole fruit, and(to not enter decimals or fractions. To Itte exlent practical, report quantities
<br /> Pennsyivan{aAve NVl,Vdashnglon,DQ2U460.P{ease include tit(,0AfC3 wniroi number in any cemesuondertce.Do NOT send the coaeptand manifest rising appropnate. fruits o1 measure Ilia[will allow you to report quantilies with prpC!Slon.
<br /> fomnstothisaddrass.Privacy Ad Sratem=_nt-None Ohre inlorroahon co'vcted under Pieddarr'estocp(6m rs Waste quanfllles entered should be, based of) ociUal [Ilea stir elmatl is 01 1ensonably accillate,
<br /> Inramatlov iPlq� Cud faunal -- u s I r o,aGo-----, --__ � estimate,of actual quantities shipped. Container cnpacdfes are, fro[ acceptable. as estimates.
<br /> i Instructions for Generators Item 12, Units of Measure (Weight/Volume)
<br /> fem 1. Generalor's U.S. EPA Identification Number Enter, la designated hoxes, the appropriate ahbreviation from Tablo II (belmll) for the colt of
<br /> Enter the generator's U_S. EPA twelve-digii identification number, or the stale generator measure,
<br /> identification number if the generator site does not have an EPA identification number TABLE IF--UNITS OF MEASURE
<br /> tem 2. Paw i of G = Gallons (liquids only). N = Cubic Frloters_
<br /> Enter the total numbei of pages used to complete this manifest(i.e., the first page (EPA Form K - Kilograms_ P Pound,
<br /> 8700-22)plus the numberof continuation shoels(EPA Fonm 8700-22A), if any). L = Liters (liquids only). T Tons ()000 Patutds).
<br /> tern 3. E-mergency Response Phone Number Ni = Motric Tons (1000 kilograms). Y = Cubic Yards.
<br /> Enter a phone number for which emergency response information can be attained in Inc event Note_i ons, Metric Tons, Cubic Illeters, and Cubic Yards should only be leper led for very
<br /> of an Incident during transportation.The emergency rosponse phone number must large bulk shipment,, such as rail cars, lank trunks, or bargos
<br /> 1. Be the number of life generator or the number of an agency or organization who is Item 13 ffWaste Codes
<br /> capable of and accepts responsibility for providing drtar ted information about [he Enter tip to six federal and scale hrasie codes to describe each waste shearni rdenlifled in Item
<br /> shipment, 9b. Stalls wasie codes flat are not redundant v;lith federal codes mfisl be (,mated here, in
<br /> 2. Reach a phone Ilia[ is monitored 24 hours a clay at all Bores the waste is in transportation addition to trip federal waste wades which are most roprerentative of the piofedfes of the
<br /> (including transportation reloled storage), and wasle.
<br /> 3- Reach someone who is either knowledgeable of the hazardous waste being shippers and petit 14. Specs ii t landliog Inshuctions and A loh'i0ti al inlbrlw4jon
<br /> has comprehensive emergency response rand spill cleanup/incident mitigation intonation 1. Generaiors may enter any special handling or shipmPnl spoohc informaton necessary
<br /> for the material being shipped or has immediate access to a person who has that knowledge for the proper management or imd(ing of the materials under Ili a (jenrtiai it's of allot
<br /> and inionnation about Me shipm ;nl. handler's business prod ;es, such ns w +°tp pnohle nurnh,m", contain :f colles !)at
<br /> Filter( y f '.i ' ' y " ' 3l°,theft cladl?!', or Ie`.pDnSSi Iluvic lilJrnbel S. ( ene.ta[Ofs also inov LSe [h h,Space 10 enlef
<br /> Note: Frnerc one Ices hdiss phone number infoini ahon should only he entered In Itpm
<br /> there fs one phone, n nmbei that,,,&pies to all tia waste malorrals described in item On ti a additional dpstanpuvp informaiu n about ttleu stopped nird^rial: :,ucn as chemical
<br /> situation (e.g., consolidated shipw nts) arises where more Ilan one Emergency Response names, consfifuent tenceniace, ahy; scat Rafe, or s&oche gravl y,of fAr sle, idt nhhod
<br /> phone number applies, to the various wastes listed on ate manifest, the phone numbers I J f t
<br /> wlil volume units in item 12.
<br /> associated v✓fih each specific fnaierial should be. entered after its description in Item 9b.
<br /> re 2
<br /> tom 4- tt9anifest Tracking Number _ l mar .;aacoc nlray he tisen 10 record Iirrfled types of fpdwaillp gt�ireu dl lonrihon for which ihere is no spe.cilic space provided on the nl tides( including any, i[pfnrife facility
<br /> This unique tracking number must he pre-printed on [he manifest by the forms printer. designations, the manifosf Iracking number of the original manifesi for rejpcted wasfeas
<br /> tom 5. Generator's Mailing Address, Phone Numbot and Sile Address sift) tesidues ihiti me iG :ihiirptxl under rr ° ec:ond fnanifc sl; and the sp,c ifu aUon of
<br /> Enter fife name of fhe generator, the rnalnuf address to which fife completed manifest signed polychiofinaied blrlhollyl (P( B) waste descnphons and PCB out of ;ervice a cif.., ,efauo'A
<br /> by the designated facility should be marled, and the gonerator's telephone number. Note, the under 40 Cf R 761,207 G000fators, hornovet, cannot he required to enlel iniormatlon in
<br /> telephone number(including area code) should be the normal business number for fire this to moot shlrtt regulaiory requirelmenrs
<br /> genpiatoi, or the numtaet where the generator of his authorized agent may be reached to /!ern 0 Uenel,-lit» Cailifications
<br /> provide; instructions in fire event the designated and/or altemale (if any) lacilily rejects some of 1 They ry,ntd'atui moist it d, sign, and drills tile,waste nrlililly:lfion r erlific„-droll sta[erriettl in
<br /> oII y if this address ptrient Iso enter It te,d tionant i fanttf esical site rnailing address diass from which the shipment o iginates b
<br /> my f J SI tning (he waste m numnation cciillication Slritpmesu thrice gpnefatprs who hrnrp not
<br /> heel l exempted by Nicoll(, of feguiutlon #coin lie duty in luokH a Vtaste minfrnlzal on
<br />'tern 6. Transporter 1 t�Urnparly Name, and U.S. EPA ID Nurnher cerllfic:ation under sechon M02(1)) of RGRA alo also c crulyrig that they huvo cornpred
<br /> Enter the company name and ITS. EPA ID number of the first transporter who will transport the wish the waste minirinizadon fequire.rnenis. The Genetaior's Coi cilication also contains the
<br /> waste Vehicle or driver intonation may not be entered here, oqtired ailc`;lalkon that the shipnrenl has boen pfopeliy,ntpa cd and is In pirrpef
<br />'tem 7. Transporter 2 Coinpany Name and U.S. EPA ID Number condition for transportation (fit(', shipper's certification) The cement of ill(- shipper's
<br /> If applicable, enter the company name and U.S. EPA ID numberof the second transporter certification siatoment i, as follows: "I hereby declare that the contents of thus
<br /> who will ifanspori the waste. Vehicle or driver infonmaron may not be, entered here. con.aiunnic;ld aro fully and accufalefy descrihi:d above by the ploper shipping name,and
<br /> If more than two transporters are needed use a continuation sheel(s)(EPA Form 8700-22A). ate. c :7sitpd, packaged, marked and labeled/placmclod, and ate in all respells in proper
<br />'tern 8. Designated Facility Name, Site Address, and U.S EPA ID Number condition for transport according to applicable nalemraronai Bind national goverrnnental
<br /> Enter the company nirme and site address of the facility designated to receive (he waste listed regulations if oxporl shipment and Fail) the Primary Lxporioi, I certify that tie contents of
<br /> on this manifest. Also enter fire, facility's phone number and the U.S. EPA twelve-digit this consigrimeni conform to ills, forms of Flo attached EPA Admovdpdgtaranl of Consenl.'
<br /> identification number of the facility_ Whorl a party other than the generator prepares the shipment for fiansporrafon,this party
<br />'tern 9. U.S. DOT Description (/ncluding Proper Shipping Name, Hazard Class or Division, may also sign tie shipper's certdication statement as the offeror of the shipment.
<br />'dentification fiVurnber, and Packing Group) 2- Generator or OfIciot personnel mey preptnal tie words, "On behalf of in tie signature
<br /> Item 9a. If the wastes identified in Item 91h consist of both hazardous and nonhazardous black or may hind write this statement in lbe signature block punt to signing the
<br /> materials, then identify the hazardous materials by entering air "X" in this Item next to the geera[oilofferot certification, to indicate that the individual signs as the employee or
<br /> corresponding hazardous material identified in Item 9b. agent of the named ponc.,ipal.
<br /> item 9h. Enter the U.S. DOT Proper Shipping Name, Hazard Class or Division, Identification Note: All of rho ahmve information excapt the henoavritfen signalure regL1110 a 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 signalures are not applicable if the genorafot is preparing and signing
<br /> technical name(s)bind toportable quantity references, if applicable. an electronic manifest using EPA's e-Manifest system )
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