Hazardous Waste Cargo Manifest Form
Generator Information
Generator Name
Site Address
City
State
Zip Code
EPA ID Number
Contact Number
Transporter Information
Transporter Name
EPA ID Number
Contact Number
Vehicle Number
Designated Facility Information
Facility Name
EPA ID Number
Address
City
State
Zip Code
Contact Number
Waste Description
Container Type
Number of Containers
Quantity
Unit
Waste Description
Waste Code
kg
lbs
tons
kg
lbs
tons
Special Handling Instructions & Additional Information
Signatures
Generator Signature
Date
Transporter Signature
Date
Facility Signature
Date