Hazardous Waste Disposal Manifest
Generator Information
Company Name
Contact Name
Phone
Address
City
State
ZIP
Transporter Information
Company Name
Contact Name
Phone
Address
City
State
ZIP
Disposal Facility Information
Facility Name
Contact Name
Phone
Address
City
State
ZIP
Waste Description
Waste Name
Description
Quantity
Unit
Hazard Class
UN/NA Number
Special Handling Instructions
Signatures
Generator Signature
Date
Transporter Signature
Date
Facility Signature
Date