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Hazardous Waste Management Program Revised 3/21/16 3,&.83$1'5(48,5(''2&80(176 WM - WASTE MANAGEMENT SERVICE PROVIDER 32 Some states require scheduled pickups. In most states, stores will initiate a pickup only when a bin is full. )RU+D]DUGRXV:DVWHSLFNXS&RPSOHWHWKH1RQ6DOHDEOH&KHFNOLVWVDQGID[WR:DVWH 0DQDJHPHQWDW,I\RXGRQRWUHFHLYHDID[FRQ¿UPDWLRQWKDWWKHID[ZDVUHFHLYHGFDOO Waste Management at 1-866-819-1926. Stores should plan to have all hazardous waste removed, not just the bin that is full. Ensure the Hazardous Waste Call/Pick Up Log is complete. )RU8QLYHUVDO:DVWHSLFNXS Complete the Universal Waste Pick-up Request Form and fax to :DVWH0DQDJHPHQWDW,I\RXGRQRWUHFHLYHDID[FRQ¿UPDWLRQWKDWWKHID[ZDV received, call Waste Management at 1-866-819-1926. Stores should plan to have all hazardous waste removed, not just the bin that is full. Ensure the Hazardous Waste Call/Pick Up Log is complete. Waste Management will provide this information to the Transporter. Once the Transporter has the LQIRUPDWLRQWKHSLFNXSLVVFKHGXOHGDQGWKH6WRUH7HDP/HDGHUZLOOUHFHLYHFRQ¿UPDWLRQRIWKHSLFN up date. 7KH7UDQVSRUWHUZLOOFRPSOHWHD³+D]DUGRXV:DVWH0DQLIHVW´WKLVLVEDVLFDOO\WKH%LOORI/DGLQJ%2/ showing the removal of the waste. This manifest will be updated with the items or the weight that the Transporter is removing. The Transporter will leave one copy of this manifest with the Store Leader. The Store Leader must keep this for their records. This document must be retained, along with all of the Non-Saleable Hazardous Material Checklists, and placed behind the Vendor Log tab in the 3URJUDP%LQGHULQWKH0DQDJHU¶V2I¿FHINT’LTR ANSPORTERDESIGNATED FACILITYEPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year Transporter 2 Printed/Typed Name Signature Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space Quantity Type Manifest Reference Number: Full Rejection Partial Rejection Residue 18b. Alternate Facility (or Generator) Facility's Phone: U.S. EPA ID Number 18c. Signature of Alternate Facility (or Generator) Month Day Year 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)1. 2.3.4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year Import to U.S. Export from U.S.Port of entry/exit: _________________________________________________________ Transporter signature (for exports only): ฀ ฀ ฀ ฀ ฀ Date leaving U.S.: ฀ 16. International Shipments Please print or type. (Form designed for use on elite (12-pitch) typewriter.) ฀ ฀ ฀ ฀ ฀ Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Generator's Phone: 6. Transporter 1 Company Name U.S. EPA ID Number 9a. HM 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, and Packing Group (if any)) 10. Containers No. Type 11. Total Quantity 12. Unit Wt./Vol.13. Waste Codes 1. 2. 3. 4. 14. Special Handling Instructions and Additional Information 15.฀ GENERATORS/OFFERORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, ฀ marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary ฀ Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. ฀ I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 8. Designated Facility Name and Site Address U.S. EPA ID Number Facility's Phone:GENERATOR7. Transporter 2 Company Name U.S. EPA ID Number 1. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) VOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOIDVOID No. TypeNo. Type 11. Total Quantity VOIDVOID 14. Special Handling Instructions and Additional InformationVOIDVOID GENERATORS/OFFERORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, an marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international a Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if VOIDVOIDVOIDVOIDVOID $¿QDOPDQLIHVWZLOOEHVHQWWR\RXUVWRUH,WPXVWEHVWDSOHGWRWKHRULJLQDOPDQLIHVWDQG1RQ6DOHDEOH +D]DUGRXV0DWHULDO&KHFNOLVWVEHKLQGWKH9HQGRU/RJWDE7KH¿QDOPDQLIHVWLVW\SLFDOO\UHFHLYHG within 45 days of the original pickup. All of these documents must be maintained for 3 years, in the Vendor Binder.