Form 8700-22A Continuation Sheet

Please print or type. (Form designed for use on elite (12-pitch) typewriter.)
UNIFORM HAZARDOUS WASTE MANIFEST 21. Generator ID Number
(Continuation Sheet)

Form Approved. OMB No. 2050-0039
22. Page

23. Manifest Tracking Number

24. Generator's Name

U.S. EPA ID Number

25. Transporter _______ Company Name

U.S. EPA ID Number

26. Transporter _______ Company Name
27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number,
and Packing Group (if any))

28. Containers
No.
Type

29. Total
Quantity

30. Unit
Wt./Vol.

31. Waste Codes

GENERATOR

27a.
HM

DESIGNATED FACILITY

TRANSPORTER

32. Special Handling Instructions and Additional Information

33. Transporter _______ Acknowledgment of Receipt of Materials
Printed/Typed Name

Signature

Month

Day

Year

34. Transporter _______ Acknowledgment of Receipt of Materials
Printed/Typed Name

Signature

Month

Day

Year

35. Discrepancy

36. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)

EPA Form 8700-22A (Rev. 3-05) Previous editions are obsolete.

DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)