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<br /> U.S.EPA Form 8700.22 Y.
<br /> Item f0.Containers(Numberand Type)
<br /> Read all instructions before completing this form, (. ..anter the number of containers for each waste and the appropriate abbreviation from Table I
<br /> I. This form has been designed for use on a 12-pitch(elite)typaw(d Mibi&Is'plso compatba jbillow)for the type of container.
<br /> with standard computer printers:'%fin poihtpen may also be used.�press davn hard. - TABLE L-TYPES OF CONTAINERS'
<br /> Federal regulations require.gBnerstor5 and transporters ofhazardglis.waste%and owners or BA=Budap,doth,paper,or plastic bags. DT=Dump,muck.
<br /> operators of hazardous wastelreadnent;storage,and disposal fadiMiesld complete this form CF=Fiber or plastic boxes,cartons,cases. DW.=Wooden drums,barrels,kegs.
<br /> (EPA Form 8700-22)and,if necessary,the continuation sheet(EPA Form 8700-22A)for CM Metal boxes',cartons,cams(including HG=Hopper or. Mole cars.
<br /> both inter-and intrastate transportation of hazardous waste. roll-08s). Go
<br /> Public mpomng burden lathe collection oflnforms0on is estimated so events, 30minutesforgeneratti ,io CW=Wooden boxes,cartons,cases. TC=Tank cars.
<br /> patent"for lrensporbrs,and 25 minimal orownera or operators of treatment,storage,and'dlapmal facilites.This "'CK=Cylinders. TP=P�p�i,t.a.ble tanks,
<br /> includes time for reviewing instructions,respiring dab.complefine,reviewing and nonsmiang Ne turn.Any DF.'=Fiberboard or plastic drums,barrels,kegs. TT=Capita tanks think trucks).correspondence regarding Na PRA burden state
<br /> mentlerthe,nantesl ramal be seat up the Director Na Collection OM=Metal,rNarm$,barrels,kegs..
<br /> Strategies Dgvgsion In EPA's ores aflmorabon Collection aide fallowing dates.: U.S.Environmenbl -peon 11 Total 62fdehfity
<br /> Prelecllon Agency(2922T),1200 Pennsyhame Ave..NW.,Washington.DC 20460.Do not send
<br /> The completed ban td this address. Enter,in designated boxes,the totalquantityof waste. Round partial units to the nearest
<br /> whole unit,and do not enter decimals or fractions. To the agent practical,report quantities
<br /> I.Instructions for Generators using appropriate units of measure thaf!will allow you to report quantities with precision.
<br /> item 1.Generator's U.S.EPA Identification Number Waste quanfities entered should be based on actual measurementsor reasonably accurate:.
<br /> estimates of actual quantities shipped. ContoinercapaciAesamnotacceptableasmbmates.
<br /> Enter the generators U.S.EPA twelve digit identification number,or the State generator Item 12 Units of Measure(Weigh Wolume) -
<br /> idenfifiatlon number if the generator site does not have an EPA identification number.
<br /> Item 2 Page 1 of_ Enter,in designated boxes,the appropriate abbreviation from Table II(below)for the unit of
<br /> measure.
<br /> Enter the total number of pages used to complete this Manifest(i.e.,the first page(EPA Form TABLE II.-UNITS OF MEASURE
<br /> 870042)plus the number of Continuation Sheets(EPA Form 8700-22A),it any).
<br /> item 3.Emergency Response Phone Number G=Gallons(liquids only). N=Cubic Meters,
<br /> K=Kilograms. P=Pounds. !'
<br /> Enter phone number for which emergency response information can be obtained in the event L=Liters(liquids only). T=Tons(2006 Pounds).
<br /> :'of an incident during transportation. The emergency response phone number must M-MatOclrMS(1000 kilograms), r..;.y Cub! YardsY -
<br /> '..1..Be the number of the generator or the number of an agency or organization who is capable - -
<br /> of and accepts responsibility for providing detailed information about the shipment; Note Tons,Metric Tons,Cubic Meters�Al�Gdrbid 4isshould only.be reported,in
<br /> 2. Rea&a phone that is monitored 24 hours a day at afi0lmes the waste is in transportation connection with very taiga bulk shipments,such as`'rsil ars,tank Wcksywr barges:
<br /> (including transportation regaled storage);and Item 13.Waste Lodes -
<br /> 3, k9ach someone who is either knowledgeable of the hazardous waste being shipped and Enter up to six federal and state waste codes to describe each wastostreamIdentified in Item
<br /> Ras comprehensive emergency response and Spill-cleandpfncident mitigation intonation 9b. State waste codes that are not redundenl with federal codes must be entered here in
<br /> ° ''forage materiel being shipped.or has
<br /> immediate access to a person who has.that knowledge additon to the federal waste codes which are most representative oftl{a:'pro riles of Ne
<br /> and Information about the shipment waste. I'v
<br /> Note: Emergency Response phone number information should only be entered in hem 3 when Item 14.Special Handling instructions and Additional Information
<br /> there is one phone numbe(t�'afapplies to all the waste materials described in Item 9b. If o I. Generators may enter any spedal handling or shipment-specific information necessary for
<br /> situation(e.g.,consolidated Shipments)arses where more than rine Emergency Response' - the proper management or tracking of the materials under the generators ur-gther
<br /> phone number applies to the various wastes listed on-the manifest,the phone numbers handler's business processes,such as waste profile numbers,contains G.46des,.bar codes
<br /> associated with each specific material should be entered after its descdption in Item 9b. or response guide numbers. Generators also may use this space to erttpf.addhional
<br /> Item 4.Manifest Tracking Number descriptive information about their shipped materiels,such as&emica harries,constituent
<br /> This unique tracking number must be pre-printed on the manifest by the tons printer. percentages,physical stale,or specific gravity of-wastes identifie"ith volume units In
<br /> Item 5.Generator's Mailing tem 12.ng.Address,Phone Number and Site 2. This space may be used to record limited types of federally required information for which
<br /> Enter the name of the geneTalor,the mailing address to which the completed mandest signed there is no specific space provided on the manifest,including any atemata facility
<br /> by the designated facility should be mailed,and the generators telephone number. Note,the designations;the maNfestrovided numberofifet,including any tfermjle far wastes and
<br /> telephoneincludingarea code)should be the normal businessnumberfor the residues that are re-shipped under a second mani(es esfldthe sped(tcaton of PCB waste
<br /> generator,or the
<br /> number where the generator or his authorized agent may be reached to descriptions andPCB out-of-service dates required ender40 CF13i81.207. Generators,
<br /> pmvitTa'Instmchons In the evert the designated and/or alternate(If any)facility rejects some or - however,cannot be required to enter information in r the thhs•soff to meat state regulatory
<br /> all of the shipment. Alm enter physical$he address from which the shipment oni inafes requirements.
<br /> :onlyifthis address-isbifferent than the mailing address. - hem r'5.GenersrorsrOtTerors Certifications
<br /> 6.Trenspoderl Company Name,and U.S.EPA ID Number 1. The generator must read,sign,and date the waste minimization cerfifica7rn statement..In
<br /> Enter the company name and U.S.EPA ID number of the first transporter who will transport the signing the waste minimization certification statamilrit;those generetorswho have not
<br /> waste. Nitride ordriver information may not be entered here, bash exempted by statute or regulation from the duty to make a waste minimization
<br /> Item 7.Transporter Company Name and U.S.EPA ID Number certification under sedan 3002(b)of RCRA are also certifying that they have complied.
<br /> If applicable,enter the company name and U.S.EPA ID number of the second transporterwho with the waste minimization requirements. The Genersto's Certification also contains the
<br /> will transport the waste. Vehicle or driver information may not be entered here. required attestation that the shipment has been property prepared and Is in proper
<br /> 1f more than two transporters are needed,use a Continuation Sheets)(EPA Form 8700-22A). . ��condition for transportation(the Shippersarlifcation). The content of the shippers
<br /> Item 8.Designated FacilityName,Site Address,and U.S.EPA 1D Number certification statement is as folows: 'I hereby declare that the contents of this
<br /> Enter the company name and site address of the facility dedgnatetltareceive the waste listed consignment are fully and accurately described above by the proper shipping name,and
<br /> are classified,packaged,marked and labeledlplacarded,and are In all respect in proper
<br /> on this maotfest. Also enter the facility's phone number and the U.S.EPA twelve digit condition for transport according to applicable intemational and,nalional governmental
<br /> Identification number of the fadfity, regulations. If export shipment and I am the Primary Exporter,I certify that the contents of
<br /> Item 9.U.S.DOT Description(Including PruperShipping Name,Hazard Class or Division, this consignment conform to the terms of the attached EPA Acknowledgment of Consent'
<br /> Identification Number,and Paclu'ng Group) When a party other than the generator prepares the shipment for transportation,this party
<br /> Hem ga. If the wastes identified in Item 9b consist of both hazardous and nonhazardous may also sign the shippers certAiation statement as the offeror of the shipment,
<br /> materials,then Idenfify the hazardous materials by entering an"X'in this item next to the 2. Generator or Offeror personnel may preprint the words,'On behalf of'nthe signature
<br /> corresponding hazardous material identified in Item 9b. block or may hand write this statement in the signature block prior to signing lige
<br /> Item 9b. Enter the.U.S.DOT Proper Shipping Name,Hazard Class or Division,Identification generatodofferor modification,to indicate that the individual signs as the employee or agent
<br /> Number(UNtNA)and Packing Group for each waste as identified in 49 CFR 172. Include of the named principal.
<br /> technical name(s)and reportable quantity references,if applicable, Note: All of the show information except the handwritten signature required in Item 15 may
<br /> Note: If additional spew is needed forwaste descriptions,enter these additional descriptions be pre-printed.
<br /> in Item 27 on the Continuation Sheet(EPA Form 8704224). Also,If more than one
<br /> Emergency Response phone numberappliesto the various wastes described in either Item 9b
<br /> mltem 27,enter applicable Emergency Response phone numbers immediately following the -
<br /> shipping descriptions for those Items.
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