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INSTRUCTIONS FOR COMPLETING MANIFESTS

INSTRUCTIONS FOR GENERATORS

Item 1.

Generator’s U.S. EPA ID Number – Manifest Document Number: Enter the generator’s U.S. EPA twelve-digit identification number and if desired, the unique five-digit number assigned to this Manifest (e.g., 00001) by your company.

Item 2.

Page 1 of ___: Enter the total number of pages used to complete the Manifest plus the number of Continuation Sheets, if any.

Item 3.

Generator’s Name and Mailing Address: Enter the name and mailing address of the generator. The address should be the location that will manage the returned Manifest forms.

Item 4.

Generator’s Phone Number: Enter a telephone number where an authorized agent of the generator may be reached in the event of an emergency.

Item 5.

Transporter 1 Company Name: Enter the company name of the first transporter who will transport the waste.

Item 6.

U.S. EPA ID Number: Enter the U.S. EPA 12-digit identification number of the first transporter identified in Item 5.

Item 7.

Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. If more than two transporters are used to transport the waste, use a Continuation Sheet(s) and list the transporters in the order they will be transporting the waste.

Item 8.

U.S. EPA ID Number: If applicable, enter the U.S. EPA 12-digit identification number of the second transporter identified in Item 7.

Item 9.

Designated Facility Name and Site Address: Enter the company name and site address of the facility designated to receive the waste listed on this Manifest. The address must be the site address, which may differ from the company mailing address.

Item 10.

U.S. EPA ID Number: Enter the U.S. EPA 12-digit identification number of the designated facility identified in Item 9.

Item 11.

U.S. DOT Description: Enter the U.S. DOT Proper Shipping Name, Hazard Class, and ID Number (UN/NA) for each waste as identified in 49 CFR 171 through 177. For non-RCRA hazardous wastes, describe per instructions in the Appendix to Chapter 12, Title 22, California Code of Regulations, Division 4.5.

Item 12.

Containers (No. and Type): Enter the number of containers for each waste and the appropriate abbreviation from Table 1 (below) for the type of container.

Table I – Types of Containers

DM=

Metal drums, barrels, kegs

DW=

Wooden drums, barrels, kegs

DF=

Fiberboard or plastic drums, barrels, kegs

CW=

Wooden boxes, cartons, cases

CF=

Fiber or plastic boxes, cartons, cases

BA=

Burlap, cloth, paper, or plastic bags

TP=

Tanks, portable

TT=

Cargo tanks (tank trucks)

TC=

Tank cars

DT=

Dump truck

CY=

Cylinders

CM=

Metal boxes, cartons, cases (including roll-offs)

 

Item 13.

Total Quantity: Enter the total quantity of waste described on each line.

Item 14.

Unit (Wt./Vol.): Enter the appropriate abbreviation from Table II (below) for the unit of measure.

Table II – Units of Measure

G=       Gallons (liquids only)

P=        Pounds

T=        Tons (2,000 lbs.)

Y=       Cubic yards

L=        Liters (liquids only)

K=       Kilograms

M=      Metric tons (1,000 kg)

N=       Cubic meters

Item 15.

Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation, treatment, storage, or disposal information or Bill of Lading information. For international shipments, generators must enter in this space the point of departure (City and State) for those shipments destined for treatment, storage, or disposal outside the jurisdiction of the United States.

Item 16.

Generator’s Certification: The generator must read, sign (by hand), and date the certification statement. If a mode other than highway is used, the word "highway" should be lined out and the appropriate mode (rail, water, or air) inserted in the space below. If another mode in addition to the highway mode is used, enter the appropriate additional mode (e.g., and rail) in the space below.

INSTRUCTIONS FOR TRANSPORTERS

Item 17.

Transporter 1 Acknowledgement of Receipt of Materials: Enter the name of the person accepting the waste on behalf of the first transporter. That person must acknowledge acceptance of the waste described on the Manifest by signing and entering the date of receipt.

Item 18.

Transporter 2 Acknowledgement of Receipt of Materials: Enter, if applicable, the name of the person accepting the waste on behalf of the second transporter. That person must acknowledge acceptance of the waste described on the Manifest by signing and entering the date of receipt.

Note – International Shipments – Transporter Responsibilities: Exports – Transporters must sign and enter the date the waste left the U.S. in Item 15, and for RCRA hazardous waste exports, must ensure the waste is accompanied by an EPA Acknowledgement of Consent. Imports: RCRA hazardous waste shipments that are transported into the U.S. from a foreign country must be accompanied by a Manifest; non-RCRA hazardous waste shipments transported from a foreign country into or through California must also be accompanied by a Manifest. Transporters who transport any hazardous waste into the U.S. from abroad must assume generator responsibilities for completion of the Manifest [40 CFR 263.10(c)(1)].

INSTRUCTIONS FOR OWNERS OR OPERATORS OF TREATMENT, STORAGE, OR DISPOSAL FACILITIES

Item 19.

Discrepancy Indication Space: Refer to California Title 22, Section 66264.72 and 66265.12, 40 CFR 264.72 and 265.72 for help in completing this part. In this space you must note any significant discrepancy between the waste described on the Manifest and the waste you actually received. If you cannot resolve significant discrepancy within 15 days of receiving the waste, you must submit a letter to your DTSC Regional Administrator describing the discrepancy and your attempts to reconcile it. A copy of the Manifest at issue must be enclosed with the letter.

Item 20.

Facility Owner or Operator: Certification of Receipt of Hazardous Materials Covered by This Manifest Except as Noted in Item 19. Print or type the name of the person accepting the waste on behalf of the owner or operator of the facility. That person must acknowledge acceptance or the waste described on the Manifest by signing and entering the date of receipt.

THIS MANIFEST IS FOR SHIPPING OF HAZARDOUS WASTE (Health and Safety Code section 25160 (b)). IT IS THE GENERATOR’S RESPONSIBILITY TO DETERMINE WHETHER A WASTE IS HAZARDOUS (22 California Code of Regulations section 66260.200 (c)). INTENTIONALLY OR NEGLIGENTLY STATING ON THIS MANIFEST THAT A NON-HAZARDOUS WASTE IS HAZARDOUS IS A VIOLATION OF LAW (Health and Safety Code section 25189.2 (a) and 25191 (a) (1)).

CALIFORNIA REQUIRED ITEMS

Generators to Enter:

  1. If you will be paying the Disposal Fees due under Section 25174 of the Health and Safety Code directly to the Board of Equalization (Board), enter your Hazardous Waste Fee Account number issued by the Board for paying the fees due under this section. This account number is a 12-character number beginning with HA or HY. Other Board numbers you may hold are not valid for this purpose. Any person willfully falsifying or misusing their account number to evade or defeat the payment of the fees is guilty of a felony. If you do not have an account number and are subject to these fees, you should contact the Board at (916) 323-9555, Monday through Friday, between 8 a.m. and 5 p.m.
  2. [Reserved]
  1. [Reserved]
  1. Enter the California waste category number. Select appropriate number from Table III. Review entire table before selecting a number. For RCRA waste(s), enter the EPA’s hazardous waste code from 40 CFR 261.30-33. To obtain federal assistance, call 800-424-9346 between 8:30 a.m. and 4:30 p.m. eastern time.
  1. Enter chemical composition for each waste category. List components corresponding to the waste category entered.

TSDF Operator to Enter

  1. Enter EPA ID number.
  1. Enter waste handling code(s). Select appropriate code(s) from Table IV.

Table III

California Restricted Waste:

  1. Liquids with cyanides > 1,000 Mg./L
  1. Liquids with arsenic > 500 Mg./L
  2. Liquids with cadmium > 100 Mg./L
  3. Liquids with chromium (VI) > 500 Mg./L
  4. Liquids with lead > 500 Mg./L
  5. Liquids with mercury > 20 Mg./L
  6. Liquids with nickel > 134 Mg./L
  7. Liquids with selenium > 100 Mg./L
  8. Liquids with thallium > 130 Mg./L
  1. Liquids with polychlorinated biphenyls > 50 Mg./L
  1. Liquids with halogenated organic compounds > 1,000 Mg./L
  1. Solids or sludges with halogenated organic compounds > 1,000 Mg./Kg.
  1. Liquids with pH < 2
  2. Liquids with pH < 2 with metals
  1. Waste potentially containing Dioxins.

California Nonrestricted wastes:

Inorganics

  1. Alkaline solution (pH > 12.5) with metals (antimony, arsenic, barium, beryllium, cadmium, chromium, cobalt, copper, lead, mercury, molybdenum, nickel, selenium, silver, thallium, vanadium, and zinc)
  2. Alkaline solution without metals pH > 12.5
  3. Unspecified alkaline solution.
  1. Aqueous solution (2 < pH < 12.5) containing reactive anions (azide, bromate, chlorate, cyanide, fluoride, hypochlorite, nitrite, perchlorate, and sulfide anions)
  2. Aqueous solution with metals (< restricted levels and see 121)
  3. Aqueous solution with total organic residues 10 percent or more
  4. Aqueous solution with total organic residues less than 10 percent
  5. Unspecified aqueous solution
  1. Off-specification, aged, or surplus inorganics
  1. Asbestos-containing waste
  1. Fluid Catalytic Cracker waste
  2. Other spent catalyst
  1. Metal sludge (see 121)
  2. Metal dust (see 121) and machining waste
  1. Other inorganic solid waste

Organics

  1. Halogenated solvents (chloroform, methyl chloride, perchloroethylene, etc.)
  2. Oxygenated solvents (acetone, butanol, ethyl acetate, etc.)
  3. Hydrocarbon solvents (benzene, hexane, Stoddard, etc.)
  4. Unspecified solvent mixture
  1. Waste oil and mixed oil
  2. Oil/water separation sludge
  3. Unspecified oil-containing waste
  1. Pesticide rinse water
  2. Pesticides and other waste associated with pesticide production
  1. Tank bottom waste
  1. Still bottoms with halogenated organics
  2. Other still bottom waste
  1. Polychlorinated biphenyls and material containing PCBs
  1. Organic monomer waste (includes unreacted resins)
  2. Polymeric resin waste
  1. Adhesives
  1. Latex waste
  1. Pharmaceutical waste
  1. Sewage sludge
  2. Biological waste other than sewage sludge
  1. Off-specification, aged, or surplus organics
  1. Organic liquids (nonsolvents) with halogens
  2. Organic liquids with metals (see 121)
  3. Unspecified organic liquid mixture
  1. Organic solids with halogens
  2. Other organic solids

Sludges

  1. Alum and gypsum sludge
  1. Lime sludge
  1. Phosphate sludge
  1. Sulfur sludge
  1. Degreasing sludge
  1. Paint sludge
  1. Paper sludge/pulp
  1. Tetraethyl lead sludge
  1. Unspecified sludge waste

Miscellaneous

  1. Empty pesticide containers 30 gallons or more
  2. Other empty containers 30 gallons or more
  3. Empty containers less than 30 gallons
  1. Drilling mud
  1. Chemical toilet waste
  1. Photochemicals/photoprocessing waste
  1. Laboratory waste chemicals
  1. Detergent and soap
  1. Fly ash, bottom ash, and retort ash
  1. Gas scrubber waste
  1. Baghouse waste
  1. Contaminated soil from site clean-ups
  2. Household wastes
  3. Auto shredder waste

Table IV

01

Recycle

02

Injection Well

03

Landfill

04

Land Application

06

Surface Impoundment

07

Thermal Treatment (includes incineration)

14

Transfer Station

15

Tank Treatment

16

Treatment Pond (excludes evaporation)

99

Other

REFER TO 40 CFR, PART 262, APPENDIX AND CCR, TITLE 22, DIVISION 4.5,

CHAPTER 12, APPENDIX

 
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