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Get EPA 8700-22 2005

Generator ID Number WASTE MANIFEST 2. Page 1 of 3. Emergency Response Phone 5. Generator s Name and Mailing Address 4. Discrepancy I Residue I Partial Rejection I Full Rejection DESIGNATED FACILITY Manifest Reference Number 18b. Alternate Facility or Generator 18c. Signature of Alternate Facility or Generator 19. Hazardous Waste Report Management Method Codes i.e. codes for hazardous waste treatment disposal and recycling systems Printed/Typed Name EPA Form 8700-22 Rev. 3-05 Previous editions are obsolete. Manifest Tracking Number Generator s Site Address if different than mailing address Generator s Phone 6. Transporter 1 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address Facility s Phone 9a. HM GENERATOR D I O V 10. Please print or type. Form designed for use on elite 12-pitch typewriter. Form Approved* OMB No* 2050-0039 UNIFORM HAZARDOUS 1. Manifest Tracking Number Generator s Site Address if different than mailing address Generator s Phone 6. Transporter 1 Company Name U*S* EPA ID Number 8. Designated Facility Name and Site Address Facility s Phone 9a* HM GENERATOR D I O V 10. Containers 9b. U*S* DOT Description including Proper Shipping Name Hazard Class ID Number and Packing Group if any 14. Special Handling Instructions and Additional Information No* Type 11. Total Quantity 12. Unit Wt. /Vol* 13. Waste Codes TR ANSPORTER INT L 15. GENERATOR S/OFFEROR S 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. Signature Month Day Year Generator s/Offeror s Printed/Typed Name 16. International Shipments Import to U*S* Transporter signature for exports only 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name I Export from U*S* Port of entry/exit Date leaving U*S* 18. Discrepancy I Residue I Partial Rejection I Full Rejection DESIGNATED FACILITY Manifest Reference Number 18b. Transporter 1 Company Name U*S* EPA ID Number 8. Designated Facility Name and Site Address Facility s Phone 9a* HM GENERATOR D I O V 10. Containers 9b. U*S* DOT Description including Proper Shipping Name Hazard Class ID Number and Packing Group if any 14. Containers 9b. U*S* DOT Description including Proper Shipping Name Hazard Class ID Number and Packing Group if any 14. Special Handling Instructions and Additional Information No* Type 11. Total Quantity 12. Unit Wt. /Vol* 13. Special Handling Instructions and Additional Information No* Type 11. Total Quantity 12. Unit Wt. /Vol* 13. Waste Codes TR ANSPORTER INT L 15. GENERATOR S/OFFEROR S 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. .

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