Republic of the Philippines

Department of Environment and Natural Resources

ENVIRONMENTAL MANAGEMENT BUREAU- CALABARZON Region
6Floor DENR Bldg. By the Bay, 1515 Roxas Boulevard, Ermita, Manila
Tel. No.: 522-8177; 404-1610; 536-9784; 536-3095
E-mail:emb_r4a@denr.gov.ph
Visit us at http://www.emb.gov.ph

HAZARDOUS WASTE MANIFEST SYSTEM

Hazardous Waste Generator’s Name:

DENR ID No.:
Generator’s Address:
Tel. No.:
Fax No:

PTT No.: M-PTT-

Manifest No.: M-M-4A-

Waste Class and Waste Number

HW Number:
Quantity (MT):
Date of Transport:

HW Number:
Quantity (MT):
Date of Transport:

Packaging Information:

Special Handling Instructions:

Transport Type: Land Water

Land Transporter:
Water Transporter:
2nd Land Transporter:
Treater:

I hereby declare that the content are fully described above and are classified, packed, marked and
labeled and in all respect in proper condition to transport to approved TSD facility in accordance
with applicable national regulations.

Signed by Owner or Authorized Representative:

Signature over printed name:

Designation:
Date Signed:

Transporter No. 1

Actual Quantity Hauled:

Date of Transport:
Vehicle (Plate number and Type): ______________________________________________
Driver Name(s): _____________________________________________________________
________________________________________________________________________
Signed by Owner or Authorized Representative:

Signature over printed name:

Designation:
Date Signed:

HWM Manifest Form 2018

Transporter No. 2

Actual Quantity Hauled:

Date of Transport:
Vehicle (Plate number and Type): ______________________________________________
Driver Name(s): _____________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Signed by Owner or Authorized Representative:

Signature over printed name:

Designation:
Date Signed:

Generator: (Company Name)

Signature over printed name:

Designation:
Date Signed:

Transporter #1: (Company Name/DENR ID No.)

Signature over printed name:

Designation:
Date Waste Received:

Transporter #2: (Company Name/DENR ID No.)

Signature over printed name:

Designation:
Date Waste Received:

TSD Premise/Operator: (Company Name/DENR ID No.)

Signature over printed name:

Designation:
Quantity of Waste Received:
Date Waste Received:

FOR DENR USE ONLY

HWM Manifest Form 2018