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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.ManifestTracking Number (� <br /> WASTE MANIFEST L-ctpQ ,q ' 3 7 1 800-535-5053-INFOTRAC p 0 0 0 5 fl 3 3 W�V <br /> 5.Generator's Name and Mailing Addressen for' Site Ad ress(if d' rent than mailing address) <br /> Generator's Phone: -�i Gly 9 5Z <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000399638 <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 ENVIRONMENTAL INC. <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> and Packing Group if an Quantity Wt.Nol. 13.Waste Codes <br /> HM 9 P( any)) Na. Type h' <br /> 1. ()LIDED-AI35Qf � .v....___._.. -DM—__ —+— <br /> t <br /> a <br /> 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORB ENT/PAPE R DM P 352 <br /> LU <br /> FILTER MEDIA) <br /> L4 oc <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTEIUSED DM P 352 <br /> METAL OIL FILTERS) <br /> 4, <br /> 94 <br /> f I <br /> 14.Spycial Ha�dhng Instructions and Additional Information t" <br /> =�;� r,T6F1EE�,+ 9132)PROFILEA USE G�1 �j LES <br /> . ASSGIRSENT-). (PAPER FILTER) 9t33)!� METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTALAS REGISTRANT. INFOTRAC 800-535=5053 <br /> 15. GENERATOR'S10FFEROR'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 proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cer iTy that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certity that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)tit I am a small quantity generator)is true. <br /> Gen rs Pr ed/Typed Nae Signa Month Day Year <br /> r ; <br /> J <br /> A 6.Intemalional Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> U3 17.TransporterAcknowledgmenl of Receipt of Materials <br /> Transporter 1 PdritedlTyped Name rr Signature Month Day Year <br /> 0 <br /> 1� r tr-.-5 D f f <br /> Z Transporter 2 Printed/Typed Nam Si re Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity Type Residue Partial Rejection Full Rejection <br /> ciion <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> Facility's Phone: <br /> W loc.Signature of Alternate Facility(or Generator) Manth Day Year <br /> Q <br /> Z <br /> 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Cn <br /> UJ 1. J2, Al <br /> 3. 4. <br /> v <br /> 20.Designated Facility Owner or Operator:Cerlifca' n of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrinledlTyped Name Signature MonthGDay Year b1 l � <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGN T D FACILITY TO EPA's e-MANIFEST SYSTEM <br />