INT'LTR ANSPORTER
DESIGNATED FACILITY
EPA 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. 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.
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:
GENERATOR
7. Transporter 2 Company Name
U.S. EPA ID Number
1.
DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)
