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Pleas_a print or type.(Form deg�se on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST � d , 018 0 4 2 8 6 7 J J K 5.Generator's Name and Mailing Address-,. 1_ Generator's Site Address(if different than mailing address) Generator's Phone: U 6.Transporter 1 Company Name U.S.EPA ID Number C'LEANTEC.H EW11RONMENT:`:_ CALO003681W 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number CLEANTECH ENVIRONMENTAL 5820 MARTIN RD IRWIND.ALE,CA 91706 USA Facility's Phone:25-812-7200 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.NOWRCRA HAZARDOUS WASTE SOLID(ABSORBENT! '? P -.5i IX PAPER FILTER MEDIA Z 2.. C HAZARDOUS WASTE SOLID(OILY SOLID WASTEICUSEP D110 P 5" c� METAL OIL FILTERS) e04 3.NON-RCRp HAZARDOUS VASTE SOLID(USED ABSORBENT) 4 14.Special Handling Instructions and Additional Information 981)PROFILEV 9B2)PROFILE# 953)PROFILEP USE GLOVES AND GOGGLES TANKEf&!�— TAPER FILTER) (MET.AL'F'ILTERS) (USED ABSORBENT) MUST IDENTIF f CLF-ADATErH REGISTRANT: INFOTRAC 800-535-5503 15. GCNERATORVOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descdbeyl above byJKe proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and natian,F.6vemme0fal regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. ,. 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 spli quantitygenerator)is true. Generator's/Off s Printedrryped Name Signature Month Day Year —J 16.International Shipments 1= ❑Import to U.S. ❑Export from U.S. Port of entry/exit: M Transporter signature(for exports only): Date leaving U.S.: W 17,Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed lT ped Nam Signature Month Day Year a [ Q (,A/L Trans edlryp Name Signature Month Day Year 0- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J ' V ua. Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a ' z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling,systems) ® 1' 2' 3. 4 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedlryped Name pp Signature Month Day Year it EPA Form 8700-224Rev.3-05) Previous editions are obsolete. ;li ION STATE(IF REQUIRED)