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Please print of type. <br /> wmw <br /> UNIFORM kAZAR00U5 �''na : !a ,Num <br /> WASNr FprmR�draa}.OMB No.fit}4 0039 <br /> ?.Page i o1 d.Ernergeracy Response Phone 4,Manifest <br /> ''frrac/kiinp TEPYIANIFEST CQc L0CZ0 Li 753 L}-1 1 860-535-5053-ItrIFQTRAC a .} U U+t1 •?. �ly��� <br /> 5.0 eneralor's Name and MaHMg Address �,� C0 G� yr,f �����g an mailing address] <br /> HDPF' pry <br /> Genaralors Phone. Zi Ct,, <br /> 6.Transpouler 1 Company Ida ma <br /> CLEANTECH ENVIRONMENTAL INC. U.S.EPA 10 Number <br /> 7.rraruparer 2 Company Nama CAL40{3399638 <br /> U•5.EPA 10 Number <br /> 8.Ues gnaled Faeinty Name acrd S is Address <br /> CLEANTECH ENVIRONMENTAL INC. UZ EPA 11)Number <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE.CA 91708 USA <br /> Facilily�Phonic: 626-812-7200 <br /> 9a, 9b.U.S.DOT Oesc4lip lincluding Proper Shipping Name.Hazard Class,fl]Num , <br /> ber <br /> Hm ar-d Pecking Grmp(0 any)) iQ,Conlrnners 1I.Tow 12,Unit <br /> No. Type [7uanlily u1R,+VaI. 13 Wasle Code; <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED A8SORBENT) <br /> QM P 352 <br /> 300 <br /> w 2• NON-RCFiA HAZARDOUS WASTE SOLIQ {AB5�7R8ENTIPAPER <br /> ca FILTER MEDIA) OM P 352 ! <br /> Ll <br /> 00 <br /> 4 <br /> 14_SpecolHandling lnsfruclbrks andAddifional tfrrormation <br /> 9B1)PR <br /> pFILE# 9B2)PR0FILE USE GLOVES AND GOGGLES <br /> (ASSOR13ENT) (PAPER FILTER) - <br /> CALLER MUST IDENTIFY CLEANTECH ENViRONM ENTAL AS REG[STIR AC 800-535=5053 <br /> 15. GENERATOR'SOFFEROR'5 CERnFICATioni r hereby declare chat tho conlenls of(his conaignn-eril are falig and acturalely described above by the prooar shippiny(Tame,and are a assTad,packaged, <br /> marked and Iabeledrplacardel,and are is aN rcspeds in pfow condihn for iranspad al carding 19 appliCa$larnlf fna[ionatand natgnaf goysrrmenlal ragula I oRS.If export sl rrd *a i am the Primary <br /> Expo ter,I cea4ly[hat the conlenrs of ihl6 consignmord conform to the lerms a the altached EPAAcknowledymrr l of Consegil. <br /> tAMq Thal lue tiraslc rn nemizdlion sWlemenl idonlif od in 48 CFR 20Z2F{a}{ir I am a large quagV gene [ar}er{G}(ll l am a srngli gdanlhy generalar)IS Irua <br /> Ge ralcr'sla �s FdnledfTyped Name Si sture <br /> 16.hllefna!iAflal ilipmenis <br /> ❑Impod to US. LIE <br /> from U.S. pod of entrylex l <br /> Tramsporler sipnalufe{for experts only); <br /> ❑ate r avir. S.. <br /> 17,Transposer AekrTuwladgrnenl of tiaralpt of IAa lonals <br /> Tlansport�1 PdnleeyTyped Name 1 <br /> �� Slgaalure llonlh pay Year <br /> a _r <br /> aTranspoder2Pnnle2 ZV <br /> F a fe IUasnih Day You <br /> 16.OiscrepeRv <br /> f ea.DI5Crepaniy IrdiraGon 5psca <br /> ❑ 4Uanlily D Typo ❑Residue <br /> ❑Partial RGorl ❑Fink Reiedion <br /> F 16b.AWnale Fabrily(OF Generatar} plan is i Reieronce iJumher- <br /> =4 U.S.EPq IO rduniLer <br /> U <br /> 1� Facjrgq phone <br /> LL <br /> tSc.Sigmatura of Allornale Fawlily{or Generalorl <br /> NorO Day Year <br /> 19.ilatardaw Waste Reparl 4lana,ensenl P+3ettlod Codes(i e.,codes for hazardousvaste treatment•d sposa4 and recyGir g sysWrns] <br /> 2f1.Oasionalod Facility Otivmer r�1Cr;Cerlifreapml of re ' cf haze dour Inalerlels covered by the nanifes!es+xpl as raed in it Ida <br /> Frinledltypetl Name 5ignalGro <br /> TM <br /> EPA Fa 8700-22(R --------------------------------- <br /> 12-17) Pi2tious edilron5 are obsolete. ` ' <br /> DE I NATER FACILITY TO EPA's e-MAlNIFES T SYSTEP1 <br />