Laserfiche WebLink
Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 11.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST t V l 019 7 4 3 2 01 JJ K <br /> 5.Generator's Name and Mailing Add s, t Generators S'e 'dre (itdi enj 1h�r�g address) <br /> rv�KI�Idj1, � <br /> Generator's Phane,:o <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH EIUVIRLNMENTAL INC CAL000368136 <br /> 7.Transporfer2 Company Name U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 USA <br /> Facility's Phone: 626"812-7200 <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 Wt.Nol, <br /> a 1. NON-RCRA HAZARDOUS WASTE SOLID(ASSORBENTIPAPER PIL-TEM DM P 352 <br /> o MEDIA] <br /> uu <br /> w 2. NON•-RCR.A HAZARDOUS WASTE SOLID(OILY SOLID WASTEIUSED DM (100P 352 <br /> CD METAL OIL FILTERS) <br /> 3. NON-RE#RFrhE'tZP RDOUS-WAST-E-SOID�-(tlSE-D-AUSORBENTI <br /> 4. <br /> 14.Special Handling Instructions nd Additional I`formation <br /> 981)PROFILE# )PROFILE � �� AR4PQrEII s# Il E GLOVES AND GOGGLES # �- <br /> (PAPER FILTERS'} (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENV)RONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 <br /> 16, GEN ERATOR'SlOPFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the propershipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international a;0natiogovernmental 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 EPAAcknowledgmenl of CoDW <br /> 1 certify that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b am all 'ty generator)is true. <br /> Generator'slOfferor's PdntedTTyped Name Signature Month Day Year <br /> GP� <br /> 16.Pntemational Shipments <br /> F ❑Import to U.S. ❑Exportfro Port of entrylexit- <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W17.TransporterAcknowledgment of Receipt of MateriIs <br /> Transporter 1 PrinledfTyp d Name I Si ture Month Day <br /> a Year <br /> �5 <br /> a YOE <br /> z Transpoder 2 PrintedlTyped Name Signatur Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Ouantty ❑Type y ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> M 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,odes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ p 1 \ 1 t 2. U 3. 4. -. <br /> L <br /> 20.Designated Facility Owner or Operator: eHification of receipt of ha -us materials covered by the manifest except as noted in Item 8 <br /> PrintedlTyped Name y� Signature Month Day Year h —;V� I <br /> f <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIG ED FACILITY ©EPA's e-MANIFEST SYSTEM <br />