Electronic Waste Disposal Manifest
Manifest Number
Date
Generator (Company/Organization Name)
Contact Person
Phone Number
Address
Transporter Name
Transporter Signature
Transporter Phone
Transporter Address
Disposal Facility Name
Facility Address
Facility Phone
Items for Disposal
Item Description
Quantity
Serial Number (if any)
Weight (kg)
Remarks
Total Weight (kg)
Special Instructions
Generator Signature & Date
Facility Representative Signature & Date