2560-FM-BWM0055H Rev. 3/2012
Form
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
55H
Hazardous Waste Transporter Quarterly Manifest Summary Report
A. General Information
Transporter EPA ID No.
Page
of
Quarter
January-March
April-June
July-September
October-December
Year
Transporter Name
B. Quarterly Manifest Summary
For each manifested hazardous waste shipment transported this quarter, record separately below the weight of
hazardous waste delivered to treatment, storage, disposal or incineration facilities, or to recycling facilities, or of
cleanup waste exempt from the fee. Use one report line below for each hazardous waste stream described on
individual manifests. Express all weights in tons rounded to the nearest tenth (0.1) of a ton. 1 Cu. Yd. = 1 Ton,
1 Ton = 2,000 Pounds, 1 Gallon = 8 Pounds, 1 liter = 2.1 pounds, 1 kilogram = 2.2 pounds, metric tons divided by
0.91 + tons.
L
i
n
e
Manifest
Tracking
Number
Page
No.
Line
No.
a
b
Treatment, Storage
Disposal or Incineration
Weight (tons)
Recycle
Weight
(tons)
c
Exempt
Cleanup
Weight
(tons)
d
Total Weight
(tons)
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Total
Lines
1-10
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