S
Uniform Hazardous Waste Manifest
Federal law requires that any facility that generates more
than 100 kilograms (220 pounds or approximately one-half of
a 55-gallon drum) of hazardous waste (or 1 kilogram of acute-
ly hazardous waste) in a calendar month use the completed
Uniform Hazardous Waste Manifest when shipping its haz-
ardous waste off-site.
Remember—you must use the Manifest of the state to
which you are sending the waste. If that state does not have its
own version of the Manifest, use the Manifest form of the
state in which you generated the waste.
If neither the state to which you are sending your waste
nor the state in which your waste was generated has its own
Manifest form, you may order Manifest forms from commer-
cial companies that produce the federal version of the
Manifest, or obtain copies from some hazardous waste treat-
ment, storage, or disposal firms.
Items 1 through 20 (and 21 through 35 on the continua-
tion sheet) constitute the federal portion of the Manifest form.
Items A through K comprise the state portion of fhe form.
When using a state form, follow the instructions provided
with that form. If you are not using a state form, ask your
state hazardous waste agency whether you must fill in items A
through K. Contact your state hazardous waste agency, your
hauler, and the facility that is to receive your waste shipment
to be sure you complete all the necessary items oh the
Manifest.
Instructions
ITEM 1.
Generator's U.S. EPA ID Number
- Manifest Document Number
Enter the generator's U.S. EPA
12-digit identification number and
the unique 5-digit you assign to
this Manifest (e.g., 00001).
ITEM2.
Page 1 of
Enter the total number of pages
used to complete this Manifest,
i.e., the first page (EPA Form
8700-22) plus the number of
Continuation Sheets (EPA Form
8700-22A),ifany.
ITEM 3.
Generator's Name and Mailing
Address
Enter the name and address of
your business.
ITEM 4.
Generator's Phone Number
Enter a telephone number where
an authorized agent of your com-
pany may be reached in the event
of an emergency.
ITEM 5.
Transporter 1 Company Name
Enter the company name of the
first transporter who will transport
the waste.
ITEM 6.
U.S. EPA ID Number
Enter the U.S. EPA 12-digit iden-
tification number of the first trans-
porter identified in Item 5.
ITEM 7.
Transporter 2 Company Name
If applicable, ertter the company
name of the second transporter
who will transport the waste. If
more than two transporters are
used to transport the waste, use a
Continuation Sheet(s) (EPA Form
EPA/530-SW-90-027s
8700-22A) and list the trans-
porters in the order they will be
transporting the waste.
ITEM 8.
US. EPA ID Number
If applicable, enter the U.S. EPA
12-digit identification number of
the second transporter identified in
Item 7. NOTE: If more than two
transporters are used, enter each
additional transporter's company
and U.S. EPA 12-digit identifica-
tion number in items 24-27 on the
Continuation Sheet (EPA Form
8700-22A). Each Continuation
Sheet has space to record two ad-
ditional transporters. Every trans-
porter used between the generator
and the designated facility must be
listed.
ITEM 9.
Designated Facility Name and
Site Address
Enter the company name and site
address of the facility to which
you are shipping the waste listed
on this Manifest. The address
must be the site address, which
may be different from the compa-
ny mailing address.
ITEM 10.
U.S. EPA ID Number
Enter the U.S. EPA 12-digit iden-
tification number of the designat-
ed facility identified in Item 9.
ITEM 11.
U.S. DOT Description (including
Proper Shipping Name, Hazard
Class, and ID Number [UNIN A])
Enter the U.S. Department of
Transportation (DOT) Proper
Shipping Name, Hazard Class,
and ED Number (UN/NA) for each
waste as identified in 49 CFR 171
through 177. Your hauler or the
facility to which you are shipping
the waste may be able to help you
determine this information. You
may also be able to obtain infor-
mation and assistance from the
U.S. Department of Transportation
(DOT) at 202-366-5580, Materials
Transport Bureau, your state trans-
portation agency, your state haz-
ardous waste management agency,
or your trade association.
ITEM 12.
Containers (No. and Type)
Enter the number of containers for
each waste and the appropriate ab-
breviation for the type of contain-
er:
DM = Metal drums, barrels, kegs
DW = Wooden drums, barrels,
kegs
DF = Fiberboard or plastic drums,
barrels, kegs
TP = Tanks portable
TT = Cargo tanks (tank trucks)
TC = Tank cars
DT = Dump truck
CY = Cylinders
CM = Metal boxes, cartons, cases
(including roll-offs)
CW = Wooden boxes, cartons,
cases
CF = Fiber or plastic boxes, car-
tons, cases
BA = Burlap, cloth, paper or plas-
tic bags
ITEM 13.
Total Quantity
Enter the total quantity of waste
described on each line. Your mea-
surement must include the weight
of the container when the waste
container is to be discarded (ex-
ample: a drum containing waste).
Do not use fractions or decimals.
ITEM 14.
Unit (WtJVol.)
Enter the appropriate abbreviation
for the unit of measure for each
quantity entered under Item 13, as
follows:
G = Gallons
P = Pounds
T = Tons (2,000 pounds)
Y = Cubic yards
L = Liters
K = Kilograms
M = Metric tons (1,000 kilo-
grams)
N = Cubic meters
ITEM 15.
Special Handling Instructions and
Additional Information
Use this space to indicate special
transportation, treatment, storage,
or disposal information or Bill of
Lading information.
ITEM 16.
Generator's Certification
You must sign and date the
Uniform Hazardous Waste
Manifest after you have filled it
out. You must certify that you
have made a good faith effort to
minimize your waste generation
and to select the best waste man-
agement method that is available
to you and that you can afford.
Printed on recycled paper
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Form Approved. OMB No. 2050-0039. Expires 9-30-91
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UNIFORM HAZARDOUS
WASTE MANIFEST
3, Generator's Name and Mailing Address
4. Generator's Phone ( )
5. Transporter 1 Company Name
7. Transporter 2 Company Name
1 . Generator's US EPA ID No
I I I I I II
- Manifest
Document NO.
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8.
9. Designated Facility Name and Site Address 1O.
1
US EPA liD Number
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US EPA ID Numbe
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US EPA 10 Number
1 1 . US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number)
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J. Additional Dswipttons f'
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IS. Special Handling Instructions and Additional Information
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2. Page 1 Information in the shaded areas
is not required by Federal
of law.
A. State Manifest Dofcument h
B, State Generator's ID
C, kvw Transports*'* Ijk
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0, Transporter's Phone
6. SWfr Transporter's (0
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ainers 13. 14.
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1 6. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by
proper shipping name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway
according to applicable international and national government regulations.
If 1 am a large quantity generator, 1 certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be 1
economically practicable and that 1 have selected the practicable method of treatment, stor.ige, or disposal currently available to me which minimizes the present and 1
future threat to human health and the environment; OR, if 1 am a small quantity generator, 1 have made a good faith effort to minimize my waste generation and select 1
the best waste management method that is available to me and that 1 can afford. |
Printed/Typed Name
Si£
nature
Month Day Year
I I I I I I I
17.Transporter 1 Acknowledgement of Receipt of Materials 1
Printed/Typed Name
Si£
nature
Month Day Year
I I I I I I I
1 8 Transporter 2 Acknowledgement of Receipt of Materials |
Printed/Typed Name
Si£
19. Discrepancy Indication Space
(nature
Month Day Year
1 1 1 1 1 1 1
.!
20,Facitity Owner or Operator: Certification of receipt of hazardous materials covered by this
Printed/Typed Name
Si£
(nature-
manifest except as noted in Item 19. |
Month Day Year
i i i i i i !
EPA Form 8700-22 (Rev. 9-88) Previous editions are obsolete.
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