Industrial Waste Manifest Form PDF Details

The Industrial Waste Manifest form serves as a critical tool in the management and tracking of nonhazardous industrial waste from its point of generation to disposal. Essential for ensuring compliance with regulations concerning the transportation and disposal of such waste, it meticulously records the journey of waste material. This document includes information about the generator of the waste, including their name, contact details, and address, alongside the generating and disposal site names, addresses, and contact numbers. Importantly, the form requires detailed descriptions of the waste, including the Rumpke approval number, container count and type, and total quantity with the appropriate unit of measure—tons, cubic yards, or gallons. Equally vital is the generator's certification, where they confirm the non-hazardous nature of the material according to federal standards and state laws, affirming that it has been correctly described, classified, and packaged. Transportation information is also documented, featuring details about the transporter(s), including names, addresses, and the acknowledgment of responsibility for safe transport. Lastly, the disposal site's acceptance and confirmation of the waste material, along with any discrepancies, ensure that the end of the waste's journey is accurately documented. This form not only facilitates environmental protection efforts but also aids in the regulatory oversight and safe handling of industrial waste materials.

QuestionAnswer
Form NameIndustrial Waste Manifest Form
Form Length1 pages
Fillable?Yes
Fillable fields50
Avg. time to fill out10 min 15 sec
Other namesprintable non hazardous waste manifest, rumpke manifest blank, non haz waste forms, rumpke nonhazardous waste manifest fillable

Form Preview Example

Manifest #: ____________

NONHAZARDOUS INDUSTRIAL WASTE MANIFEST

 

GENERATOR

Generator Name

 

Tel. No.

 

 

 

Address

 

 

 

 

 

Generating Location

 

 

 

 

 

Disposal Site Name

 

Tel. No.

 

 

 

Disposal Site Address

 

 

For each waste below, provide the Rumpke approval number, the total number of containers, container type (i.e. drum, tote, bulk), total quantity of waste, and units in tons (TONS), cubic yards (CY), or gallons (GAL)

Waste

Rumpke

Containers

Amount

 

Description

Approval No.

No.

Type

Total Quantity

 

Units

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Special Handling and/or Additional Information

GENERATOR CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, classified and packaged according to applicable regulations.

Print/Type Name

Signature

 

 

Shipment Date

________________________________________________ _________________

 

 

TRANSPORTER

 

 

 

Transporter 1

 

 

Transporter 2

Name of Transporter

 

Name of Transporter

 

 

 

 

 

 

Address

 

Address

 

 

 

 

 

 

 

Driver Name

 

Driver Name

 

 

 

 

 

 

 

Truck No.

 

Telephone No.

Truck No.

Telephone No.

 

 

 

 

 

I hereby certify that the above named material was transported

I hereby certify that the above named material was transported

from the above listed location.

from the above listed location.

Signature

Date

Signature

Date

____________________________________ ______________

_______________________________ ________________

 

 

DISPOSAL SITE

 

Site Name

 

 

 

 

 

 

 

 

Address

 

 

Telephone No.

 

 

 

 

 

Discrepancies:

 

 

 

 

I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate.

Print NameSignatureReceipt Date

______________________________________ _____________________________________________ __________________