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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST �73roL 1 t h 019742613 JJ K <br /> �_��� � <br /> 5.Generator's Name and Mailing Addresse _ _.zx,-'�i'lcpJ A' aWytPp (d, <br /> rent than mailing address) <br /> �rattiPhone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> t_LE NTECH EN(V!RCJN11vlFfLTAL lNo C�,4:1 00056,;;156, <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLE:[i JITEt�'H ENkk.iRC5NNIIEr'tTAL INC <br /> nnn�vn r,.e <br /> =-2'0 MARTIN FOA.D t� .w�_• __+�.._ <br /> IRVkflNDA.LE,C.°, 41706 LIS`, <br /> Facility's Phone: 626-812-7200 <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt./Vol. <br /> Of 1. NIOtd-F.CRA HAZARDOUS ".TE SOLID(ALSR_EttT.`F° rER FILTH r_:0F �,-' <br /> � <br /> 1-41EDIA) <br /> W 2 I'•tO,P�-RC�R.:".KAZ6,Ri-OUS VA-' <br /> O STE SOLID(GiL*`SOLID D,,:n.;ti_ E,r S EL <br /> [ftij F35. <br /> NlETAL OIL FILTERS) <br /> 3. i;t•�3nt-F:tOFN;Ha Yt?r}OLiS-M�f�TE; ABSORBENT) <br /> 4. <br /> 4. <br /> 14.Special Handling Instructi s a d A IRf tion ✓) , <br /> Bi)F'Rr=iFILE 92B1F'ROFILEtx -- - - USE GLO,.jES AND GOGGLES TAJV.ER*---r -- <br /> (F'.A.IPER FILTER, ttvlETAL FiLTEF;• ) E k.8_ <br /> CALLER Cd1U=T IDENTIFY CLFMN-TECH ERIVIRONIVIENITA.L AS REGISTF.ANT: INFCD T RAr : ;3130-513-5-5003 <br /> 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, <br /> 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 <br /> Exporter,i certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> Generator's/Offerors PrintedlTyped Name Signature Month Day Year <br /> VPAWL1y r0 \ l3 <br /> J 16.International Shipments <br /> 1:1Import to U.S. ❑Export from U.S. rt of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> IX <br /> Transporter t PrintedlTyped Name Signal Month Day Year <br /> O UW <br /> 13- L � I X (0 <br /> z Transpo a (typed Name C t <br /> Signature Month Day Year <br /> 9 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 52 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � <br /> 1. \�i 2. t 3. 4. <br /> 20.Designated Facility Owner or Operator:Certificatio f receipt of hazardous mate ri s covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Da Ye r <br /> t ZW L�A�6 - 0 <br /> EPA Form 8700-22(Rev.12-17) Previous editions Are obsofete. DESIGNATED F ILITY TO EPA's e-MANIFEST SYSTEM <br />