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y,: .�a z:.:,.7:' <br /> Please plint or type. t"' Form Approved.OMB No.2050-00; Q <br /> UNIFORM HAZARDOUS 1.Generator ID Number 1 2.Paige 1•df 'fEifie f ency Response P one 4.Manifest Tracking Number. <br /> WASTE MANIFEST-. l J I��s �� t l L E'` t �J 0"0242219 JJ K <br /> 5.Generalor's Name and Mailing Addressenerator Site Address if differenflh n mailing address) <br /> Ir- <br /> -eneratoe PHone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number y <br /> CLEANTECH ENVIROMENTAL OALOW3996M MM W <br /> 7.Transporter 2'Company Name U.S.EPA ID Number. T <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number• <br /> CLEANTECH ENVIROMENTAL CAL00033M <br /> 5820 MARTIN RD W <br /> IRWINDAL€,CA 91705 USA <br /> Facility's Phone:62&-•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)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 0 1' NON-RCRA HAZARDOUS WASTE SOLID(ABSORBENT/PAPER FILTEF DM P 352 <br /> MEDIA) 0 Ln U <br /> w <br /> L 2. NON-RGRA HAZARDOUS WASTE SOLID(OILY SOLID WASTEIUSED WA P 352 <br /> METAL_OIL FILTERS) G' <br /> 3. <br /> NON-RGRA FIMZd+rFtDO .{IVA TE SOLID(USED ABSORBENT) <br /> ) ` DM P ' 352. <br /> ��, ,. <br /> 4. <br /> 14.Special Handling Inst ti - A c nfbrrrlation �i i� jF Vol n,T <br /> 9f31PROFILt3$1 t3 2)PROrtL� _ 9B3)Pf OFILE# "1 3 USE GLOVES AND GOGGLES TANKER <br /> (PAPER FILTERS) (METAL FILTERS) USED ABSORBE►ND <br /> CALLER F4UST IDENTIFY CLEANTECH ENVIRONMEIVYAL AS°REGISTRANT:INFOTRAC MO-535-5053 <br /> 15. GENERA7UR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the:proper shipping name,and are,E(6iPfied,packaged, <br /> marked ahalabeledfplacerded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and jam the Primary <br /> Exporter,l certify that the contents of this consignment conform to the terms of the a�tschea EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identifed,tn 4b CFR262,2.7(a)-(if I am a large.quantity generator)or(b)(III am a small quantity generator)Is true.: <br /> Generator'slOfferors Printed(Typed Nama Signature Month Da Year <br /> = 4 - - ►� t <br /> 16.International Shipments f " <br /> j-._ '` .'❑Imliort4etJ.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: s <br /> W 17.TransporterAcknowledgment of Recetpf of Materials <br /> F- <br /> Transporter Pnntedr ype�Nane Signaturef Month D>ay Year <br /> o — j. Eta <br /> QTransporter 2 Printedlryped'Narne` Signature s.•,f �J J Month Day Year <br /> 18.Discrepancy ' <br /> 18a.Discrepancy Indication Space }4 e <br /> ❑ Quantity ❑Type El Residue El Partial Rejection OF* <br /> ull Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> u Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) Month .Day Year <br /> Q <br /> Z' <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 2. 3. 4. <br /> ILA t ; <br /> 20.Designated Facility Owner or Operator: ertification of receipt of hazardo a r�.aterials covered by the manifest except as noted in Item fna <br /> Printed/Typed Name Signature ` Month Day Year <br /> fj <br /> _ , <br /> .PA Form 8700-22(Rev.12-17) Previous editio s are obsolete. r' D€SI�NA ATED FACILITYTO GENERATOR <br />