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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) t2[* ;'4^G_. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.M519015432 If t T acking Number WASTE MANIFEST �U 1 519 015 4 3 2 JJ K 5.Generator's Name and Mailing Address �� X71 '.(G��%� 'te Address(if different than mailing address) r lt� Generator's Phone: t -AC 6.Transporter 1 Company Name CLEANTECH ENWROAENTAL NCC U.S.EPA ID Number CAL.00030136 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 5x20 MARTIN RD IRWIND&E,CA 91705 USA 812-r" Facility's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt./Vol. 13.Waste Codes 1. oil RIB 120114C VOW,= :.. d' ML O II Z 2. .. Uj METAL OIL FILTERS) 3. 4. 14.Special Handling Instructions and Additional Information Z USE GLOVES Nil(i•OOOL.ES WA(E1ilAt (PVikIE-0 FIt1E#it (ML IAL FILTERS) CALLER MUST IDENTIFY CLEAANTECH ENVIROMENTAL AS REGISTRANT-INFOTRAC:800-933-5053 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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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 small quantity genjhator)is true. Generator's/Offeror's PrintedrT=d Name Signature i Month Day Year iJ19ti -_57 16.International Shipments F-J ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year O Ia f rn Z Transporter 2 PrintedlTyped Name - Signature / Month Day Year W [/ 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Re yp ection j ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z CD 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) y 0 1. 2. l 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature .) Month ear i H �c 56 1 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR