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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 CPL-000 y33 4 77 1 800-535-5053-INFOTRAC 030015604 WAS <br /> 5.Generators Name and Mailing Address - 1 Gener tars Sile Addre if different than mailing address <br /> �e_v C o rl� X j \ ( 9 , <br /> r <br /> 515 40 P9 i7 l - �Ck��'►�1G�1� <br /> Generators Phone: pCry C)5 J Co <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000399638 <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 /> CLEANTECH ENVIRONMENTAL INC. <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE, CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> ga, 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 WI.NoI. <br /> 1, --fieN-ReRA-HA-ZA E)U-S-WA&TE9eL-ID-(USEDABSORBENT)=. -- - -- DM - P -352-- -`--...--- -- <br /> rz <br /> 0 <br /> w <br /> UJI z 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> Q9 FILTER MEDIA) _7 <br /> 3. NGN-RC-RA-HA-ZARDOUS-WAS-T-E-SOL-ID-(OIL-Y-SOLO-WA&T-EPI E)- —DM— —P--352 <br /> METAL OIL FILTERS) <br /> I <br /> 4. <br /> I <br /> 14.Special Handling Inslruclions and Additional Information <br /> -984j-P-ROFFL-E-#=====-T 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> (PAPER FILTER) S-) --- <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTALAS REGISTRANT. INFOTRAC 800-535=5053 <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 EPAAcknoviledgment 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)(ifl am a small quantity generator)is true. <br /> Gen Valor's/Offerors Prinled[Typed Name SignaI a Month Day Year <br /> la 1A <br /> J 16.Inlemalional Shipments 21 <br /> f <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(far exports only): Date leaving U.S.: <br /> UJ 17.Transporter Acknosvlecigmen(of Receipt of Materials <br /> r— Transporter 1 Printed/Typed Name n re <br /> 19 Month Day Year <br /> n0 tin l <br /> Z Transporter 2 Printed/typed Name Signature Month Oa Year <br /> cz��I e- �LI/a y <br /> 18.Discrepancy <br /> 1Be.Discrepancy Indication Space <br /> Quantity ❑Type 1:1 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 /> L� Facility's Phone: <br /> C1 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> C3 1. 2. ` 3. 4. <br /> 20.Designated Facility Owner or Operator Codificalion of receipt of hazao materials covered by the manifest except as ncld int em 18a <br /> Printed/Typed Name Signature MonthDa Year <br /> EPA Form 8700-22(Rev.12-17) Previous a itions are obsolete, E IGNATED FACI LITY TO EPA's e-MANIFEST SYSTEM <br />