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` Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone =f! ', 0016201 <br /> king Number <br /> WASTE MANIFEST 1 800-535-5053-INFOTRAC W SGe-*-a'ca\ama 3no Ma ing Address Generators Site Address(if different than mailing address) WAS <br /> /"�V <br /> c 7 ss",zr 1 Cc-oaoy Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000399638 <br /> -sx-e-2 C072a7c Name U.S.EPA ID Number <br /> c.Des g7,3:ed Faa')Name and Site Address U.S EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE, CA 91706 USA <br /> e: 626-812-7200 <br /> 9a 9b.U.S.DOT Description(induding Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit <br /> H%j and Packing Group(if,any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> O <br /> Q I <br /> iz 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> c� FILTER MEDIA) <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 <br /> METAL OIL FILTERS) <br /> d <br /> 14.Special Handling Instructions and Additional Information <br /> 961) PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535=5053 <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generators/Offerors Printed/Typed Name Signature Month Day Year <br /> J 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> of 17.Transporter Acknowledgment of Receipt of Matenals <br /> w <br /> F- Transporter 1 Prinledrryped Name Signature Month Day Year <br /> O <br /> a <br /> Transporter 2 Printed(fyped Name Signature Month Day Year <br /> t- <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ ❑ ❑Full Rejection <br /> ❑ Quantity Type Residue Partial Rejection j <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLI 1. 2, 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />