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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.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST Q U 3 'Z t 1 � Qf�' -G 019015336 J J K 5.Generators Name and Mailing essGeneralpr's Site (if diffgrenI than mailing address) LL � � �� t{NM'I11Y_ 7kt�lil✓tY1IV(�,f\) Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number 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 5820 MARTIN RD CAL00033Wb3 IRWINDALE,CA 91705 USA Facility's Phone: 626-812-7200 ga 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)) 13.Waste Codes No. Type Quantity Wt.Nol. 1. WASTE SOLID( SO BENT/PAPER FILT R DM P 352 o MEDIA) 01 4 'i Z z. P 352 LLJ METAL OIL FILTERS) 3.- i �D 4. 14.Special Handling Instructions and Additio al I mation 981)PROFILE#'l7 2)PROFILE# ?%3�� USEGLOVESANDGOOf3LEST�. (PAPER FILTER) (METAL FILTERS) (USED ASSeRBEN:F)- CALLER MUST IDENTIFY CLEANTECH ENVIROMENTAL AS REGISTRANT:INFOTRAC:800-535-5053 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 Fxpnder,I rerfify that the rnnlents of this consignment conform to the terms of the attached FPA Acknowedgment 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 generator)is true. Generators/Offeror's Printed/Typed Name Signature Month Day Year ,ri 2) ? ZJ 16.International Shipments Export from U.S. Port of ent xit: 1:1 Import to U.S. ❑ p ry Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signatur Month Day Year O a �U rn Q Tran nted yped N e Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑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 N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. 20.Designated Facility Owner or Operator:Ce cation of receipt of hazard o atedals covered by the manifest except as noted in Item 1 Printed(ryped Name Signature Mo Da Ye � EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILI TO DESTINATION STATE (IF REQUIRED)