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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 14.Manifest Tracking Number <br /> WASTE MANIFEST CL J_r, D \ �j 1 800-535-5053-I NFOTRAC 030005386 WA V <br /> b.Generators Name and Mailing Address 5 Iskft �� ` G �k�s i " ergn han mailing address) <br /> j. Ll 7 WC\ , J-�/A-,-A <br /> oIq$ M ❑aJ CP, <br /> PeneratorsZ <br /> Phone: <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 /> a.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000330453 <br /> 5620 MARTIN ROAD <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, 1.0,Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity wt./Vol, <br /> 1. G4&-WA TE?Qi9-(+JSE9- BSGRBCTDM <br /> rr <br /> z 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER DM P 352 <br /> 0 FILTER MEDIA) / -- <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 <br /> METAL OIL FILTERS) <br /> 4. <br /> i <br /> 14.S 1Handlin�Instructions and Additional Information , <br /> g�-rr,-rcvrrEE-# -- 9B2)PROFILEk72- 7 USE GL V GLES <br /> (PAPER FILTER) 9B3 "d (METAL FILTERS) <br /> `� <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535=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 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 certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment 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)of I am a Wil quantity erator)is true. <br /> Generatorsloffarors Printedffyped Name Signature Month Day Year <br /> v � - 9 Li 75 <br /> J 6.Int natiana hipmen s <br /> ❑Import Io U.S. ❑Export from U.S. entrylexil: <br /> Z Transporter signature(for exports only): Dale leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials r <br /> Transporter 1 Printed/Typed Name ]] gnature - Month Day Year <br /> 19 <br /> z Transporter 2 PrintedlTyped Name ure Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Partial Re } <br /> El Rejection LJ Full Re'eclion <br /> Manifest Reference Number: <br /> >- 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 4 <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> a 1. 2. ' 1P ` 3. —� �0 4. <br /> 20.Designated Facility Owner or Ope tor:Certification of receipt of zardous materials covered by the manifest except as noted nItEV 18a <br /> Printedffyped Name _r z� Signature ` Month Daffy Year <br /> `/11� , is t,VJ1 ti UR I <br /> -i I <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESI ATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />