1. No category

Environment and
Sustainable Resource Development
Waste Manifest Attachment Sheet
Must accompany Hazardous Waste Manifest Form
Manifest Number:
Waste Shipped From:
Waste Shipped To:
Provincial
Code
Shipping Name
Class
UN
No.
Packing
Group
Quantity
Shipped
Unit:
L/kg
Packaging
No.
Physical
State
Quantity
Received
Units
L/kg
Handling
Code
Shipment
Accepted/
Refused
Code
I certify that the information contained in Part A and above is correct and complete. I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping
name, and are classified, packaged, marked and labelled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations.
Signature (Generator): _______________________________
Date: __________
Signature (Carrier): __________________________________
Date: __________
Discrepancies? Yes:
No:
If yes, specify:
Signature (Receiver): ________________________________
Jan 2015
Waste Manifest Attachment Sheet
© 2015 Government of Alberta
Date: _________
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