ARIZONA DEPARTMENT OF ENVIRONMENTAL QUALITY
SPECIAL WASTE MANIFEST
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Instructions for the Completion of the ADEQ Special Waste
Manifest
1. Enter the generator's
Arizona Identification Number in box 1.
2. Enter the Emergency Response Notification
Phone Number in box 2.
3. Enter the
generator's name and complete mailing address, including city, state, and zip
code, along with the generator's phone number, including the area code, in box
3.
4. Enter the transporter's name,
transporter's Arizona identification number, and telephone number, including
the area code, in box 4.
5.
Complete this box if a second transporter is to be used to transport the
special waste to the receiving facility, following the instructions outlined in
number 4 in box 5.
6. Enter the
name, address, and physical site location of the primary special waste
receiving facility. In the appropriate spaces, include the facility's Arizona
identification number and the telephone number, including the area code, in box
6.
7. Enter the name, address, and
physical site location of the alternate special waste receiving facility. In
the appropriate spaces, include the facility's Arizona identification number
and the telephone number, including the area code, in box 7.
8. Enter United States Department of
Transportation description (Including proper shipping name, hazard class, and
identification number, if applicable) (For all non-Department of
Transportation-regulated materials, enter the proper name, physical state, and
description of all contents of the waste).
Mark an "X" in this column if waste is classified as a
hazardous material.
Container Number
Enter the number of containers being shipped for each
waste.
Total Quantity
Numerical value representing the number of containers
multiplied by the container size. Answer will be listed in pounds, gallons, or
cubic yards.
Unit weight or volume
P - Pounds
G - Gallons
Y - Cubic Yards
9. Use this space to indicate special
transportation, treatment, storage, or disposal information. Emergency response
telephone numbers or similar information may be included here in box
9.
10. Print or type the
generator's name followed by their signature and date in box 10.
11. Print or type the primary transporter's
name followed by their signature and date in box 11.
12. Print or type the secondary transporter's
name followed by their signature and date in box 12.
13. Indicate significant discrepancies in
this box. Significant manifest discrepancy is defined as "a difference of more
than 10% by weight for bulk shipments, any variation in a piece count for batch
deliveries, or an obvious difference in a special waste type is discovered by
inspection or analysis between the type or amount of a special waste designated
in a special waste manifest, and the type or amount received by a special waste
receiving facility" in box 13.
14.
Print or type the receiving facility's owner or operator name followed by their
signature and date in box 14.
