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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.ManifFesjt Tnrac ' NNjumb�]�' <br /> WASTE MANIFEST (�f} �j j�-( g-7 ©G f JJ K <br /> 5.Generator's Mame and Mailing Address 3 ?-� T2jQ-P-41r G for , dre if diff rent IqT ll' a e ) \t�n - <br /> c��i f�°ti�AV y to f\ ..( <br /> eneranrs"Ph e: oCSi �2 �ppt� ekq Av <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLE/d!TECH ENVIRONfvjENTAL CAL00039u'78333 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLEANTECH ENVIROPv1ENTAL CAL000330453 <br /> 5320 tOARTIN RD <br /> IRWINDALE.CA 91705 USA <br /> Facility's Phone: 526-812-720i <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(!il13.Waste Codes <br /> No. Type Quantity W1.Nol, <br /> 1' NON-RCRA 110-7ARDOUS WASTE SOLID(ABSORSEN TIPAPER FILTE L brd �R F 352 <br /> 0 <br /> w <br /> cZw7 2' NON-RCRA HAZARDOUS WASTE SOLID(OILY SOLID WASTEIUSED DPM1J <br /> N'1EGAL OIL FILTERS) ?w <br /> 4. <br /> 14,Special Handling Ins illor}� <br /> d ni rmation v <br /> {{�� i <br /> 9131 PROFILE'; 9B2)PROFI €= '�rI6Z:." USE GLOVES AN�JGOi�OLESTANKER 3 �4 <br /> (PAPER FILTEFS) (METAL FILTERS) - <br /> OA.LLER NIUST iDF_NTI 'CLENTECH EIIAAROi4,11E1]TE,L AS REGISTRANT: INFOTR;C 300-535-5053 <br /> 15. GENERATOR'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 Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable intemationaland 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 EPAAcknowledgmenl 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 /> Ge to Suture Month Day Year <br /> 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit; <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed N e �QQ Signature Month Day Year <br /> a <br /> ZTransporter 2 Prinledffyped arae nature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ©Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> F- 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> LL Facility's Phone: <br /> LLL 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> F19.Hazardous W sle Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. A\��� <br /> 12. 3. 4. <br /> 20.Designated Facility Owner or Operator:Ce ification of receipt of hazard us materials covered by the manifest except as nded in Item 18a <br /> Printed/Typed Name Ut Signature Month Day Year <br /> k1lc m � <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATE AGILITY TO EPA's e-MANIFEST SYSTEM <br />