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Please print or type. Farm 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 ��,�3C�S' Su 2 1 800-535-5053-INFOTRAC n j O 0 0 5 41 r WAS <br /> J,,1.Generator's Name and Mailing Address /A __1, &ni tors Site Address(if different than mailing address) <br /> ��.'L�'L•5 il',� «ice <br /> bb-PP T K% <br /> eneralor's Phone: <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 /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 1 <br /> HM and Packing Group(if any)) No. Type Quantity Wt. <br /> [Vol. 13.Waste Codes <br /> O fn ED ABSORBEAIT_) —.—DM_._.._---- _ P 352 <br /> - <br /> ¢ I <br /> � ( i <br /> LU 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> FILTER MEDIA) S I <br /> i <br /> 6}g—fnoriw9r�0 Yvn E/11SE M P-- 352 ' <br /> 4. I <br /> 14.Special Handling Instructions and Additional Information r' <br /> i <br /> �3B1)Rf�BFfLE ti 962)PROFILE USE GLOVES AND GOGGLES <br /> (PAPER FILTER) --9B.3)— <br /> CALLER <br /> -9B.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 Io applicable international and national governmental regulaliogs,If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to[lie terms of the attached EPAAcknowledgmen[of Consent. <br /> 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)-(ffram a s II quanlily genlgf)isd <br /> Generala sl0f"eror's PrinIe rfyped a e S re � ; Month Day Year <br /> dfr� '�' • - Cl tS 119 <br /> .international Shipments <br /> f_ Imoorl to U.S. ❑Export from US'' Port of enlrylexi:�, <br /> ? <br /> Transporter signature(for exports only): Dale leaving <br /> ce 17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> Transpo ter 1 Prinledrfyped Name u 1, gnalure Month Day Year <br /> a <br /> b i f els-- 1 <br /> Transporter 2 Printed/Typed Name Sign lure Month Day Year <br /> r- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Allemale Facility(or Generator) U.S,EPA ID Number <br /> U <br /> LL Facility's Phone: <br /> F18c.Signature of Alternale Facilily(or Generator) Month Day Year <br /> Z <br /> w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Irealmenl,disposal,and recycling systems) <br /> � 1 2. 3. 4. <br /> vi 1'` <br /> 20.Designated Facility Owner or Opera r:Certification of receipt of focus materials covered by the manifest except as noted in Ile 8a <br /> Prinledrtyped Name Signature <br /> 9 <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. Vw 17 (` <br /> DESIG t�!,',TED FACILITY TO EPA's e-MulidtFEST SYSTEM <br />