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Please print or type. 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 7LI 1 t ��: 019 7 4 3 4 0 7 JJ K 5.Generators Name and Mailing Addres ,{ ,„ � �f e rators dress 'f dl ent than mailing address) Generators Phone: Ck 97 ,-7,(�, 6-Transporter 1 Company Name U.S.EPA ID Number .:1EANTECH ENVIRONNIENT.L,L CAL000399E38 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address CAU.S.EPA ID Number t� 1+1TECH ENVIRONMENTAL ING- 5820 MARTIN ROAD A•it VijJ3L�+rJi' IRUUNDALE,CA. 91706 USA. 26-812-7200 Facility's Phone: - F 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. I. P-10111-RCRA HAZARDOUS V ASTE SOLID ,ABSOREIENT/PAPER FILTE. Dt l P 3_•2 oFOEDIk) w z 2. N- CRA HA.ZA.RDOUIS VNASTE SOLID(OILY SOLID WASTEfUSED DM _ P 352 cwa METAL OIL FILTERS) --1--NON-R RA HA +RL7cDs_t'S-N�'i+:STE S4LIG tiJ5E9,� t BEi�iT CJS 4. L t 14.Special Handling Instructions and Additionaynformation 981)PROFILE#M 9 81PRO�FILE#2 ' USE GLOVES Af4D O:OGGLES-+AHKER�c � ,,PAPER FILTERS) (NIETAL FILTERS) r=^ d0�^r.pG7�nIT\ CALLER MUST IDENTIFY Cl EANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-505= 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, kers d I P e Iplae ed and are in all res in proper condition for transport to c^� le into tlonal and national^^"emmen_I._,..a... f_..__ mar..__and.ab_I_d. ard__, r_..._..r__ _ .. ,. l..-.. ...,.,.rt according•��Fp�,.,.b n ema na e.y,,. .a,�y�,a.ions.I ceNuii;hipmeiitand 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)(ifl am a small antity generator)is true. Generators/Offerors Printed/Typed Name Signature Month Day Year hm 1v,/ j 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. of entry/exit: 91 Transporter signature(for exports only): ate leaving U.S.: of 17.Transporter Acknowledgment of Receipt of Materia s UJ Transporter 1 Printed/Typed Name ! Signat Month Day Year O z Transporter 2 Printed/Typed Name 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 tai Facility's Phone: LU 18c.Signature of Alternate Facility For Generator) Month Day Year Q Z S219.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2. ( t 3. 4.OD 20.Designated Facility Owner or Operator:VertifiGation of receipt of hazy ous materials covered by the manifest except as noted in Item 16 Printed/Typed Name Signaturenth e r 1 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNIN ED FACILITY TO EPA's e•MANIFEST SYSTEM