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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 ®A' <br /> WASTE MANIFEST A1—C`C!Vg3� " 7-7 1 800-535-5053-INFOTRAC 0 30005014 YYAS <br /> 5.Genera(ors Name and Mailing AddressGe x We SileA ss(if different than mailing address) <br /> S�"-zdCd �,(,�.W��41 t!/ Vlf1{r <br /> Generatorsh r P <br /> C n L pr <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CALOOD399638 <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. CAL000330453 <br /> 5820 MARTIN ROAD <br /> IRWINDALE,CA 91706 USA <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 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt./Vol. <br /> cr 1. 1-NGN-RCR4WA74R0OUcWA T-SOL0-(L-SE--D-ABSORBENT)..- ....... _ DM _......__.___. ---P--- .352 <br /> O <br /> rz 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> c� FILTER MEDIA) <br /> 3. NOAl �5? <br /> �T� -(- <br /> -ME-AI=-GII-FfETERS.)_-...-._ <br /> r <br /> 4. <br /> 14.SpecB1TRfIE1�l6€ialHandlinglnslruclionsandAdditonalInformation <br /> � # 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> A 6:56p i=bq (PAPER FILTER) -9B3-)— (META{-FILTERS)-- <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS 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 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 /> Generalor'siOfferors Printed/Typed Name Signa re Month Day Year <br /> J <br /> Z.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. 'Port of enlrylexil:` <br /> z Transporter signature(for exports only): Dale leaving U.S.: <br /> oo 17-TransporlerAcknowledgment ofReceipt ofMaterials <br /> UJI <br /> I-- Transporter 1 PrinledrPyped Name gnalure / Month Day Year <br /> Ln 1101 -5" � f c' <br /> z Transporter 2 PrintedrTyped Name Signalu / Month Day Year <br /> r- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> F 18b.Allemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> uu18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> Y, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ M 1, 2. 1 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt Pazarclous materialktovered by the manifest except as noted iriltern 18a <br /> Ll 11D <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.,12-17) Previous editions are obsolete. D SIGNATED FAVLITY TO EPA's e-11AAi IIFEST SYSTEM <br />