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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 a" C,E �� Z? rqnn--,q5-rnFi-INFnTRAr 1 020022889 JJ K <br /> 5.Generator's Name and Mailing Addre � rotor S, Ad ess if diff eLenl Ihan mailing address) <br /> Generator's Phone . + <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIROPJIENTAL CAL000399538 <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 /> CLEANTECI-I ENVIROfv1ENTAL <br /> 5320 AyIARTIN RD CAL000330453 <br /> IRWINDALE,CA 91705 USA <br /> Facility's Phone:626-312-7200 <br /> ga. gb.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 WtWol. 13.Waste Codes <br /> 1' 1 01\!-RCRAHAZARDOUS WASTE SOLID(ABSORBENT/PAPER FILTEF P 352 <br /> o MEDIA) <br /> W <br /> ti &DO <br /> W 2�"�n <br /> 3. aA un 7n c ern —c SQLI D DNA in ^� <br /> 4. Paa..'�.r',-�l�'.�n. ;,�' -^���e;c�nrn �{t`Z(�lL '^ rZ 352I I <br /> 14.Special Handling Instruction ��d l afoot!r�rna on <br /> 9BIPROFILE4 on r _ <br /> (PAPER FILTERS) ;,'_ ,",L LT= 5_; .B`l T ;�• E '^E GLOVES AND GOGGLES TANKER <br /> CALLER.!'MUST IDENTIFY CLEANTECH ENVIRONlt4ENTAL 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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemationaland national gov m?Vlor)istrue,I regulations.If export shipment and I am the Primary <br /> Exporter,1 certify that the contents of this consignment conform to the terms of the attached EPAAcknowled Consent. <br /> certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity g tor)or( (if I am a s all ant' <br /> Generators/Offerors Print cIyped N mnature e Si <br /> /9 •/fL/'L S g .�/ / Month Day Cear <br /> 16. nternational Shipments ` <br /> J-- ❑Import to U.S. ❑Export fro S. P rt of entrylexit: <br /> K Transporter signature(for exports only): ale leaving U.S.: <br /> W 17.TransporterAcknowledgmenl of Receipt of Materials <br /> LU <br /> O Transporter 1 Prinled/fyp dd Name Signature.! <br /> _ 1 I )} Month Day Year <br /> Z Transporter 2 Printed/Typed Name Signature (� <br /> K j Month Day Wear <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantify El Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> F� 186.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> L Facility's Phone: <br /> w 18c.Signature ofNlemaleFacility(orGenerator) Month Day Year <br /> Q <br /> z <br /> w19.Hazardous Waste Report anagement Method Codes(i.a,.codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1 2• 3. 4. <br /> 20.Designated Facility Owner r Opera!r-Certification of receipt of ha z us materials covered by the manifest except as noted in Ilem 18a <br /> Printed/Typed Name l' <br /> Signature M lh ❑ y &-rai <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNAl E FACILITY TO EPA's e PdANIFGS I Y <br />