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Please print or type. '�rt�`�LP Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.P e 1 of 3.Emergency 5 <br /> ency Response Phone 4.M ifest T acking Number <br /> WASTE MANIFEST ll II L � 2 2 2 0 6 7 JJ K <br /> �� t _ `ti� <br /> 5.Generator's Name and Mailing Address <br /> � a Sil Addre s different n mailing address)C, en raI� � <br /> 1 <br /> Generators Phone: � _, �7� ' <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CL EAN I ECH ENVI ROMENTAL CAL000399638 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> S.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLEANi'ECH ENVIROMENTAL <br /> 5820 MARTIN RD CAL00033L453 <br /> IRWINDALE,CA 91705 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)) No. Type Quantity WIJVol. 13.Waste Codes <br /> I- NON-RCRA HAZARDOUS WASTE SOLID(ABSORBENT/PAPER FILTEF P 352 <br /> o MEDIA) <br /> l�i Ems' ��o� <br /> Z 2. No LLRCRA HAZARDOI ISIULU <br /> STF Cry{{n cn{r 4'Cr]{Ifl A!A C <br /> ...–w.– i.r �..�Q-.._ r..,DM�--- - <br /> G4lL-F4L-TE-RS)- <br /> 3. - <br /> 4. <br /> 14.Special Handling Instructions an tonal Information <br /> 9131PROFILE _—po?}PRg�,� v USEGLOVES AND GOGGLES TANK.EM7 <br /> (PAPER FILTERS) - �, { ) vi'eE6�R��EKf�_ <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 inlemationaland national governmental regulations.If export shipmenland I am the Primary <br /> Exporter,I certify that the contents of This consignment conform to the terms of the attached EPAAcknowledgment 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 /> Genera lorslOK rocs Prinledrfyped Na e <br /> �' �. Signature Month Day Year <br /> 16.International Shipmefits <br /> 1:1 — " <br /> Impart to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Dale leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transpo/rter��nl�ed/T pied Name Signature/ '1 Month Day Year <br /> CL <br /> Cn <br /> Z Transporter 2 Prinlecirryped Na a Signalure Month Day Year <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> f} 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> Lu 18c.Signature of Alternate Facility(or Generator) <br /> a Month Day Year <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. ff <br /> 0 �4 lq� 2 3. 4. <br /> 20.Designated Facility O712N%7��� <br /> overed by the manifest except as cted in Item 18a <br /> PrinledlTyped Name Signature ! � Mon pa� YLl —IbIIN, 'N" 61"A �r <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />