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Please print or type.(Form designed for use on elite ,1-pitch)typewriter.) Form Approved.OMB No _0i, <br /> UNIFORM HAZARDOUS 1 Generator ID Number :78le <br /> of 3 Emergency Response Phone 14.�nifest Tracking Number <br /> WASTE MANIFEST CA1LDO017947" 500-535-5053-INFOTRA.0 9 2 JJ K <br /> 5 Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> SPECIALIZED TRUCK SE4' 10Ei'SH{PPER-f?FFEROR' <br /> 3565 E. CHEROKEE RD. <br /> y STOCKTON CA. 95205'USA <br /> o Generator's Phone 209-462-507$ <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> `O CLEANTECHEWRONN,iENTA.L r P <br /> O C:A D003M45•- <br /> J Transporter 2 Company Name U.S.EPA ID Number <br /> Am m <br /> LD 8 De [d F ty e A r s U S.EPA ID Number 1 F <br /> �@d 9 9&06.�LTKUTIONS LLC b OL G <br /> 1704 W 1 ST STREET <br /> �* °ZUSA., CA. 91702 USA <br /> Facility's Phone 6115-3'4.,117 <br /> ga 91b.U.S DOT Description(including Proper Shipp rm Name.Hazard Class.ID Number 10.Containers 11 Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt.Nol. <br /> NON-RCRA HAZARDOUS WASTE SOLID (OILY SLUDGE) Dbi P 352 <br /> 0 <br /> 2 <br /> L:J <br /> Z 2 <br /> LL1 <br /> a I� <br /> +�E <br /> 0 <br /> ro <br /> m <br /> r 4. <br /> N <br /> O <br /> O <br /> m <br /> 14 Special Handling Instructions am Additional Information <br /> 381)'MP# USE GLOVES AND GOGGLES TRUCK�f ly� <br /> `SLUDGE MATERDkL) <br /> C CALLER MUST IDENTIFY CLEA.NTECH EMARONMENTAL AS REGISTRANT: INFO TRAC 800-535-5053 <br /> m <br /> Z <br /> 5 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 packaaec <br /> .�z 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 Pnmary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> LuI 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 g ner or)is true. <br /> 0 s ntr <br /> o Generator's1yped Name nature Month Day <br /> s <br /> (� ed(f4 / <br /> J 16 International Shipments <br /> Q H ❑Import to U.S ❑Export from U.S. Port of entrylexit: <br /> JTransporter signature(for exports only) Date leaving U.S.. <br /> r Y w 17 Transporter Acknowledgment of Receipt of Materials <br /> r� Tran r 1 Prin�(Typed Na 1 Sign=tu � Month Day <br /> 5 0 I �'I7 T/ l�L - l <br /> ^ <br /> ` Transporter Printed/Typed Name Signatur Month Day <br /> a <br /> f-- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: _ <br /> H 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> Lar- Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) Month Day <br /> f- <br /> a � <br /> z <br /> t, 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 2. 3. <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, <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF R L- ('r <br />