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pdfForm Approved. OMB No. 2050-0039
Expiration Date: mm/dd/yyyy
Please print or type.
UNIFORM HAZARDOUS WASTE MANIFEST
(Continuation Sheet)
21. Generator ID Number
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
28. Containers
27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number,
and Packing Group (if any))
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. 12-17) Previous editions are obsolete.
DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM
Form Approved. OMB No. 2050-0039
Expiration Date: mm/dd/yyyy
Please print or type.
UNIFORM HAZARDOUS WASTE MANIFEST
(Continuation Sheet)
21. Generator ID Number
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
28. Containers
27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number,
and Packing Group (if any))
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. 12-17) Previous editions are obsolete.
DESIGNATED FACILITY TO GENERATOR
Form Approved. OMB No. 2050-0039
Expiration Date: mm/dd/yyyy
Please print or type.
UNIFORM HAZARDOUS WASTE MANIFEST
(Continuation Sheet)
21. Generator ID Number
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
28. Containers
27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number,
and Packing Group (if any))
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. 12-17) Previous editions are obsolete.
DESIGNATED FACILITY COPY
IF YOU RECEIVED THIS MANIFEST, YOU HAVE RESPONSIBILITIES UNDER THE e-MANIFEST ACT. SEE INSTRUCTIONS ON REVERSE SIDE.
Form Approved. OMB No. 2050-0039
Expiration Date: mm/dd/yyyy
III. Instructions for Owners and Operators of Receiving Facilities Designated on the Manifest
Item 35. Discrepancy Indication Space
Refer to Item 18. This space may be used to more fully describe information on discrepancies identified in Item 18a of the manifest form.
Item 36. Hazardous Waste Report Management Method Codes
For each field here, enter the sequential number that corresponds to the waste materials described under Item 27, and enter the appropriate process code
that describes how the materials will be processed when received. If additional continuation sheets are attached, continue numbering the waste materials
and process code fields sequentially, and enter on each sheet the process codes corresponding to the waste materials identified on that sheet.
Note: The e-Manifest Act mandates several changes to the federal manifest program. Beginning on June 30, 2018:
• This continuation sheet (Revision 12-17) must be used and all previous editions are prohibited.
• Any facility (e.g., a RCRA-permitted facility, Subtitle D facility) that receives a manifest and any continuation sheets accompanying a stateonly regulated waste must comply with 40 CFR 264.71 or 265.71 (use of the manifest) and 40 CFR 264.72 or 265.72 (manifest discrepancies).
• Any facility that receives a paper manifest accompanying a federally regulated waste or state-only regulated waste must submit the top copy
(Page 1) of the manifest and any continuation sheets to the U.S. EPA’s e-Manifest system within 30 days. The copies must be submitted in an
acceptable format. Submissions must be made at the mailing address or electronic mail/submission address specified at the e-Manifest
program website’s directory of services (see www.epa.gov/e-manifest).
• The facility will be assessed a fee for each manifest copy submitted.
• Go to www.epa.gov/e-manifest for the directory of services and additional information.
PRA Burden Statement:
The public burden related to the Uniform Hazardous Waste Manifest, which is approved under OMB 2050-0039, is estimated to average
(per manifest) 60 minutes for generators; 20 minutes for transporters; and 30 minutes for owners and operators of receiving facilities
designated on the manifest. This is a mandatory collection under 40 CFR Part 262, Subpart B, 40 CFR Part 263, Subpart B, and 40 CFR
Parts 264 and 265, Subpart E. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The completed form should be submitted in accordance with the
instructions accompanying the form, or as specified in the corresponding regulation. Send comments on the Agency's need for this
information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including
through the use of e-Manifest, to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200
Pennsylvania Ave., NW, Washington, D.C. 20460. Please include the OMB control number in any correspondence. Do NOT send the
completed manifest forms to this address. Privacy Act Statement - None of the information collected under the Manifest Program is
considered Personally Identifiable Information (PII) or Confidential Business Information (CBI).
Form Approved. OMB No. 2050-0039
Expiration Date: mm/dd/yyyy
Please print or type.
UNIFORM HAZARDOUS WASTE MANIFEST
(Continuation Sheet)
21. Generator ID Number
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
28. Containers
27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number,
and Packing Group (if any))
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. 12-17) Previous editions are obsolete.
TRANSPORTER COPY
Form Approved. OMB No. 2050-0039
Expiration Date: mm/dd/yyyy
II. Instructions for Transporters
Item 33. Transporter—Acknowledgment of Receipt of Materials
Enter the same number of the Transporter as identified in Item 25. Enter also the name of the person accepting the waste on behalf of the Transporter
(Company Name) identified in Item 25. That person must acknowledge acceptance of the waste described on the manifest by signing and entering the
date of receipt.
Item 34. Transporter—Acknowledgment of Receipt of Materials
Enter the same number of the Transporter as identified in Item 26. Enter also the name of the person accepting the waste on behalf of the Transporter
(Company Name) identified in Item 26. That person must acknowledge acceptance of the waste described on the manifest by signing and entering the
date of receipt.
Note: This continuation sheet reflects formatting changes made by U.S. EPA in December 2017. Beginning on June 30, 2018, this manifest
(Revision 12-17) must be used and all previous editions are prohibited. Go to www.epa.gov/e-manifest for additional information.
PRA Burden Statement:
The public burden related to the Uniform Hazardous Waste Manifest, which is approved under OMB 2050-0039, is estimated to average
(per manifest) 60 minutes for generators; 20 minutes for transporters; and 30 minutes for owners and operators of receiving facilities
designated on the manifest. This is a mandatory collection under 40 CFR Part 262, Subpart B, 40 CFR Part 263, Subpart B, and 40 CFR
Parts 264 and 265, Subpart E. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The completed form should be submitted in accordance with the
instructions accompanying the form, or as specified in the corresponding regulation. Send comments on the Agency's need for this
information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including
through the use of e-Manifest, to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200
Pennsylvania Ave., NW, Washington, D.C. 20460. Please include the OMB control number in any correspondence. Do NOT send the
completed manifest forms to this address. Privacy Act Statement - None of the information collected under the Manifest Program is
considered Personally Identifiable Information (PII) or Confidential Business Information (CBI).
Form Approved. OMB No. 2050-0039
Expiration Date: mm/dd/yyyy
Please print or type.
UNIFORM HAZARDOUS WASTE MANIFEST
(Continuation Sheet)
21. Generator ID Number
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
28. Containers
27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number,
and Packing Group (if any))
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. 12-17) Previous editions are obsolete.
GENERATOR’S INITIAL COPY
Form Approved. OMB No. 2050-0039
Expiration Date: mm/dd/yyyy
Instructions—Continuation Sheet
U.S. EPA Form 8700-22A
Read all instructions before completing this form.
Federal regulations require generators and transporters of hazardous waste and owners or operators of receiving facilities designated on the manifest to use the
uniform hazardous waste manifest (EPA Form 8700-22) and, if necessary, this continuation sheet (EPA Form 8700-22A) for both interstate and intrastate
transportation. This form must be used as a continuation sheet to U.S. EPA Form 8700-22 if:
• More than two transporters are to be used to transport the waste; or
• More space is required for the U.S. DOT descriptions and related information in Item 9 of U.S. EPA Form 8700-22.
This continuation sheet reflects formatting changes made by U.S. EPA in December 2017. Beginning on June 30, 2018, this continuation sheet (Revision
12-17) must be used and all previous editions are prohibited. Go to www.epa.gov/e-manifest for additional information.
This form must be purchased from a registered printer (https://www.epa.gov/hwgenerators/approved-registered-printers-epas-manifest-registry#how) and has been
designed to be filled out using standard computer printers; a firm point pen may also be used—press down hard. After June 30, 2018, this form can also be
completed electronically in EPA’s e-Manifest system.
I. Instructions for Generators
Item 21. Generator’s ID Number
Enter the generator’s U.S. EPA twelve-digit identification number or, the state generator identification number if the generator site does not have an EPA
identification number.
Item 22. Page ___
Enter the page number of this continuation sheet.
Item 23. Manifest Tracking Number
Enter the manifest tracking number from Item 4 of the manifest form to which this continuation sheet is attached.
Item 24. Generator’s Name—
Enter the generator’s name as it appears in Item 5 on the first page of the manifest.
Item 25. Transporter—Company Name
If additional transporters are used to transport the waste described on this manifest, enter the company name of each additional transporter in the order in
which they will transport the waste. Enter after the word “Transporter” the order of the transporter. For example, Transporter 3 Company Name. Also enter
the U.S. EPA twelve-digit identification number of the transporter described in Item 25.
Item 26. Transporter—Company Name
If additional transporters are used to transport the waste described on this manifest, enter the company name of each additional transporter in the order in
which they will transport the waste. Enter after the word “Transporter” the order of the transporter. For example, Transporter 4 Company Name. Each
continuation sheet can record the names of two additional transporters. Also, enter the U.S. EPA twelve-digit identification number of the transporter named
in Item 26.
Item 27. U.S. D.O.T. Description Including Proper Shipping Name, Hazardous Class, and ID Number (UN/NA)
For each row enter a sequential number under Item 27b that corresponds to the order of waste codes from one continuation sheet to the next, to reflect the
total number of wastes being shipped. Refer to instructions for Item 9 of the manifest for the information to be entered.
Item 28. Containers (No. And Type)
Refer to the instructions for Item 10 of the manifest for information to be entered.
Item 29. Total Quantity
Refer to the instructions for Item 11 of the manifest form.
Item 30. Units of Measure (Weight/Volume)
Refer to the instructions for Item 12 of the manifest form.
Item 31. Waste Codes
Refer to the instructions for Item 13 of the manifest form.
Item 32. Special Handling Instructions and Additional Information
Refer to the instructions for Item 14 of the manifest form.
| File Type | application/pdf |
| File Title | Continuation Sheet.ai |
| Author | prepress |
| File Modified | 2020-12-23 |
| File Created | 2006-05-08 |