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.
| Question | Answer |
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| Form Name | Industrial Waste Manifest Form |
| Form Length | 1 pages |
| Fillable? | Yes |
| Fillable fields | 50 |
| Avg. time to fill out | 10 min 15 sec |
| Other names | printable non hazardous waste manifest, rumpke manifest blank, non haz waste forms, rumpke nonhazardous waste manifest fillable |
Manifest #: ____________
NONHAZARDOUS INDUSTRIAL WASTE MANIFEST
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GENERATOR |
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Generator Name |
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Tel. No. |
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Address |
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Generating Location |
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Disposal Site Name |
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Tel. No. |
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Disposal Site Address |
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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 |
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Description |
Approval No. |
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Total Quantity |
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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 |
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Shipment Date |
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________________________________________________ _________________ |
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TRANSPORTER |
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Transporter 1 |
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Transporter 2 |
Name of Transporter |
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Name of Transporter |
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Address |
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Driver Name |
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Driver Name |
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Truck No. |
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Telephone No. |
Truck No. |
Telephone No. |
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I hereby certify that the above named material was transported |
I hereby certify that the above named material was transported |
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from the above listed location. |
from the above listed location. |
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Signature |
Date |
Signature |
Date |
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____________________________________ ______________ |
_______________________________ ________________ |
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DISPOSAL SITE |
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Site Name |
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Address |
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Telephone No. |
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Discrepancies: |
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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
______________________________________ _____________________________________________ __________________