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Please print or type.(Form designed for use on elite(12-pitch)(ypewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3 Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL"179478 1 300-535-5 i F TRAC 010440193 JJ K 5 Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) j SPECIAU?ED TRUCK SERL9CE(SHIPPER-OFFEROR) 3665 E. CHEROKEE RD. STOCKTON,CA 95205 USP.. Generator's Phone: 6 Transporter 1 Company Name U.S.EPA ID Number CLEANTECH ENVIRONMENTAL INC. C.AL0003W,36 7 Transporter 2 Company Name U.S.EPA ID Number 8 Designated Facility Name and Site Address U.S.EPA ID Number VEOL4A ES TECHNICAL SOLUTIONS LLC �UL 1704 W. i ST STREET Vn1MXlJllL�ltJ AZUSA,CA 91702 USA F.icihty's Phone:625-334-5117 qa 9b.U.S.DOT Description(including Proper Shipping Name.Hazard Class,ID Number, 10.Containers 11,Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. I NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT MATERIAL) � DNl ^� P 181 o / w Z 2 W 3. 4 14 Special Handling Instructions and Additional Information gall)WP$f USE GLOVES AND GOGGLES TRUCK# (USED BSORBENT)i CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS P,EOGISTRANT: INFOTR,AC 800-535-5053 15 GEN ERATOR'SIOFFEROR'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, marked and labeled/placarded.and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary Exporter.I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity gene (if I am a small quantity gene to is true. Generator's/Offernsel,[Typed Name, �nature Month Day Year ar r1 7 j 16 International Shipments i— ❑Import to U.S. ❑Export from U S Port of entry/exit: ? rransporter signature(for exports only). Date leaving U.S.: LU P.Transporter Acknowledgment of Receipt of Materials Transporter 1 PnntedrT ped Name Signature Month Day Year N QTransporter 2 Printedfryped Name Signature Month Day Year H 18 Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b Alternate Facility(or Generator) U.S.EPA ID Number J v I Facility s Phone: U- 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) W 1 1 2 1 3. 4. 0 20 Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedrFyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITV TO DESTINATION STATE (IF REQUIRED)