Arizona Administrative Code
Title 18 - ENVIRONMENTAL QUALITY
Chapter 13 - DEPARTMENT OF ENVIRONMENTAL QUALITY - SOLID WASTE MANAGEMENT
Article 13 - SPECIAL WASTE
Appendix B - 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.