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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1• enera or ID Number 2.Page 1 of .Emer en Re/,onse hone 4.Manifest Tracking Number WASTE MANIFEST Q l '? J -�J /J� V✓J 019015088 JJ K 5.Generator's Name a d Mailing Address l C n r I G nerator' SilAd��f rent than mailing address) �J�J6&Z tic R,(Js '!V q 1 `� X170 LI NCo1N a L-L/-b Generators Pho G G 7 'r✓I' IP 6.Transporter 1 Company Name U.S.EPA ID Number CLEANTECH ENVIROMENTAL INC. CAL000368136 7.Transporter 2 Company Name U.S.EPA ID Number 6.Designated Facility Name and Site Address CLEANTECH ENVIROMENTAL U.S.EPA ID Number 5820 MARTIN RD lKWINUALt,L;A b'1/U5 USA Facility's Phone: 626-812-7200 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes I. NON-RCRA HAZARDOUS WASTE SOLID(ABSORBENT/PAPER FILT RD ' AU P 352 o MEDIA) Z Z. NON-RCRA HAZARDOUS WASTE SOLID(OILY SOLID WASTE/USE ' DM P 352 LLI METAL OIL FILTERS) O 3. WN-R ST 4. 14.Special Handling Instructions and Additional Mot�ion 9B1)PROFILE#.27c'3��S9B2)PROFILE#Z"J.32—'5' s l"16E# USE GLOVES AND GOGGLES TANKER# (PAPER FILTER) (METAL FILTERS) CALLER MUST IDENTIFY CLEANTECH ENVIROMENTAL AS REGISTRANT:INFOTRAC 800-535-5053 �U,Zr� 15. GENERATOR'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 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 EPAAcknowledgment of Consent. I rtity that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)(if I am a small quantity generator)is true. Ge rotors/Offerors Printed(Typed Name / Signature Month Day Year 1 Inlemationa hipments ❑Import to U.S. F71 Export from U.S. Port of enlrylexit: Z Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Tr orter 1_ Pr ntedlTy Nam Sign Morith Day Year o 1-4-CL G z� ( a a ZZ Transporter 2 Printed/Typed Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ QuantityType❑ yp El Residue Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V ra Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z U) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. �4\ 2. �L\ 3. 4. 20.Designated Facility Owner or Operato Certification of receipt of hazard alerials covered by the manifest except as noted in Item 18a Printed/Typed Name � Signature � Month `Day Yeah i br/ EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACI I Y TO DESTINATION STATE (IF REQUIRED)