Hazardous Waste Manifest
1. Generator Information
Generator Name
EPA ID Number
Address
City
State
ZIP
Contact Person
Phone
2. Transporter
Transporter Name
EPA ID Number
Address
City
State
ZIP
3. Designated Facility
Facility Name
EPA ID Number
Address
City
State
ZIP
4. Waste Description and Codes
Container Number
Quantity
Unit
Waste Description
Hazardous Waste Code(s)
Container Type
Gallons
Pounds
Kilograms
Liters
Gallons
Pounds
Kilograms
Liters
5. Special Handling Instructions
6. Generator Certification
Printed Name
Signature
Date
7. Transporter Certification
Printed Name
Signature
Date
8. Facility Certification
Printed Name
Signature
Date