Hazardous Waste Manifest

1. Generator Information
Company Name EPA ID Number
Address
Contact Name Phone
2. Transporter Information
Transporter 1 Name EPA ID Number
Transporter 2 Name EPA ID Number
3. Designated Facility Information
Facility Name EPA ID Number
Address
Contact Name Phone
4. Waste Description
Container Type Number of Containers Waste Description / Proper Shipping Name Hazardous Waste Number(s) Quantity Unit
5. Special Handling Instructions and Additional Information
6. Signatures
Generator Signature
Date
Transporter 1 Signature
Date
Facility Representative Signature
Date