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a <br /> Please print or type.(Farm designed for use on elite(12-pitch)typewriter) Fo'im Approved.OMB No.2050-0039 <br /> 1.Generator ID Number 2.Pa e 1 of 3.Emer s nse Phone 4.Manifest TrackingNumber <br /> UNIFORM HAZARDOUS ] t r - g .t(g r, JJK <br /> WASTE MANIFEST L {)C 1 1 —1 y 1 �l �'"i <br /> h'`:, -t- <br /> 5.Generptor's Name and Mai4. Generato s Site Address{if different thanmailigg a dre s t• k <br /> Generators Phone:Q 4 S Z�I �- f'�q" ' �r �l�1 '�1�P "11► <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIROIiAENTAL INC. CALOODW136 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address CtEANTECH EWROMENTAL U.S.EPA ID Number <br /> 5820IlMTIN RD CAL00D' <br /> IRWIMIALE,CA 61705 USA <br /> 82"12-720D <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wi.Nol. <br /> 1. ( Sa <br /> J <br /> M 2. S 31 <br /> 4. <br /> 14.Special Handling Instructions and Ad6tienal Information <br /> &'6rYi,)PRUFIL -{�� •'�° J2)PROFILE* ? 3 I"lL� _USE OLOA/ES.AND(�OOOLES <br /> (RVER FILTER) .0*TAL FILTE S) (Lim>A68Q11111111"Po. 3 2— <br /> CALLER MLXT IDENTIFY CLEANTECH EMIIROMENTAL AS REGISTRANT:INFOTRAC 800-63bL6033 <br /> 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, <br /> marked and labeled/placarded,and are in all respects in propercondition for transport according to applicable international and national pemmental regulations.If export shipment and I am the Primary <br /> Ex=porter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent , <br /> Je6erlify 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 smali quantity geperator)is true. <br /> Gerb%q�g rs PrintedFryped Nam Signature / Mo th Jay �YYgar <br /> 1-7 <br /> _r 16.International Shipments <br /> z ❑Import to U.S. ❑Export from U.S. ' Port of entrylexit: <br /> — Transporter signature(for exports only): Date leaving U.S.: <br /> Or 17.TranspolerAcknowledgment of Receipt of Materials <br /> Tfanspgqrler,UPrintedlTyped Na , / ya Signa re —— .- Month a YJr <br /> 1 �L ' `t i�/k iy /J <br /> VJ ®� ' <br /> Z Transporter 2 PrintedfTyped Name ° Signature —� Month Day Year <br /> F <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type El Residue ❑Partial Reaction <br /> 1 ❑Full Rejeelion <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> c� <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z ' <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLIp 1 2. <br /> 20.Designated Facility Owner or Oper4or.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedfTyped NameSi nature 1 <br /> 9 }� Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DE -, ITED FACILITY TO GENERATOR <br />