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Form Approved. OMB No. 2050-0039 Please print or type. (r•orm oesiyneu wi use u.. viltu t -N 1. Generator ID Number 2. Page 1 of Emergency gespo se ho;e 4. M fie t T c u r UNIFORM HAZARDOUS `iii 9 6 3 JJ K �O ' 1 ;U ,„/;4 .• JV% I WASTE MANIFEST ll J� 5. Generators Name end Mailing Address G neralo Site Addre s (if iffier nt tha m lin addre ) If `I � �t3t l-40 � �•��` Generators-haeV ne:,v- vS ' v U.S. EPA ID Number 6. Transporter 1 Company Name CLEANTECH ENVIROMENTAL INC. CAL000368136 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address CLEANTECH ENVIROMENTAL U.S. EPA ID Number CAL000330453 5820 MARTIN RD IRWINDALE, CA 91705 USA 626-812-7200 Facility's Phone: 9a, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt.Nol. 1. NON-RERA-HAZflRDOUS WASTE-SEND{ABSOR-RENMPAPE-R-F L -T -R- D P 3521 o z. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USEM DM P 352 0 METAL OIL FILTERS) 224 d t 3. ,-- NON-RORA-HAZAR LH)4 SE -D A&SBRB€NT)— -- -- -- _-.._ ---P— 3&2- 4. 14. Special Handling Instructions and Additional Information 9B2)PROFILE; 95.,) USE GLOVES AND GOGGLES TANKER# �-R) (METAL FILTERS) (USE -D 3 CALLER MUST IDENTIFY CLEANTECH ENVIROMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 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, to intern,ationel and national governmental regulations. If export shipment and I am the Primary marked and labeledipiacarded, and are in A respeuis in proper condition for transport according applicable Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowle nt of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large y generator) or ) (if I am a small quantity generator) is true. Mgnth Day Year rot's Print d(fyped Name Signatur 16 - International Shipments ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: Z Transporter signature (for exports only): Date leaving U.S.: w 17. Transporter Acknowledgment of Receipt of Materials Month Day Year Transporter 1 Printed/Typed Name Sig re o P �l/�-- 6 Z� S Month Day Year zQ Transporter 2 Printed/Typed Name Signa re H 18. Discrepancy 18a. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 181b. Alternate Facility (or Generator) U.S. EPA ID Number J U tar- Facility's Phone: Month Day Year B 18c. Signature of Alternate Facility (or Generator) a z N19. Hazardous Waste Report Management Method Codes (i.e., codes for ardous waste treatment, disposal, and recycling systems) 0 1. 2. l 3 4 Mon D Yqr 20. Designated Facility Owner or Operator: Ce 'kation of receipt of haz ous materials covered by the manifest except as noted iTt:at:� Printed/Typed Name Signature EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACI�ITY TO DESTINATION STATE (Ill- HEUUIFiitu)