Marine Hazardous Waste Transport Manifest
Manifest Number
Date
Vessel Name
Generator (Originator) Information
Company/Organization
Address
Contact Person
Phone
Transporter Information
Company Name
License Number
Contact Person
Phone
Recipient (Facility) Information
Facility Name
Facility Address
Contact Person
Phone
Hazardous Waste Details
Description of Waste
UN No.
Quantity
Packaging Type
Hazard Class
Physical State
Remarks
Declarations & Signatures
Generator's Declaration & Signature
Transporter's Declaration & Signature
Recipient's Declaration & Signature