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Please print ort pe. Fofm Approved.OMS Nu.2DS0.403g <br /> UNIFORM HAzARDOU5 1 GeneratdrlD Number G.Page 1 el 3,Emergerq A.espoama phone 14.ManlfestTmeking Numlw <br /> WASTE MANIFEST c'�30Q 1 800.535-5053-INFOTRAC j U A�" <br /> 5.GanerOEor s Name and lwtail;ng Addr nernfar's SileRddress[ii dllferenl than mailing address) v.! <br /> c -A <br /> Gencralors phone: VO <br /> 6-Transporter t Cgmpany—NZ,. U.S-EPA ID Number <br /> GLEANTECH ENVIRONMENTAL CAL00D330453 <br /> 7.Transporter Z Ccvnpsny Name <br /> U.S.EPA Ip Number <br /> A.f]es:griaied Facllify Name and Site Address U.S.EPA W Numbor <br /> CLEANTECN ENVIRONMENTAL INC- <br /> 5620 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91708 IDSA <br /> Fndldya Phone: 826-$12-7200 <br /> ga I 91b,U.S.DOT Dessdipiion(Induding Proper Slipping Name,Hazard Class,ID Number, 10,Containers 11,TCI81 12.Unit <br /> HM and Parddng C*QV(if arry)) 7M OuarQy VyJW. 13.Waste Codes <br /> I <br /> d <br /> r � <br /> a - <br /> LU <br /> LU <br /> 2• NON-RCRAHAZARDDUS WASTE (ABSORBENTIPAPER DSA P 352 <br /> Q FILTER MEDIA) ( �' <br /> 3. rr•,ni RGRA IreAkRg WNS;Fn <br /> aEDoi <br /> d <br /> 16.Specal Handfin InSI uCt ons and Adail onal frdam 2iion <br /> 9B2}PROFILE USE PtOVES AND GOGGLES <br /> kABSONSIRNTI (PAPER FILTER) _ <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL A5 REGISTRANT, INFOTRAC 800-535=5053 <br /> 15. GEtiERATOR'SIDFFEftOR'S CE RTIFICATION; I hereby dedare Ilial rhe eadlenls of[his owmignmDAI aro fully and acmralely described above by the properskippigg rine,ord arc c ay§i tied,puGsaged, <br /> markea and taFWnrlEpiar-z dad,and ora in aU ra6(Mp in prOper evndA r frr knspao accoj&g to sppf uNe inLrr--Mkai and aesthamr ;°rpmer.xI regu!nlig s.!f expo ships.~N ad I am Ili--Prirna^r <br /> E%poder,I rcd[fy Thal the eonlenls of Ibis consigrnnenl Conform to the{gang arlhe attached EPRAr�naw[edgmgal Of CorrmnT <br /> t certify that the v+rile minxnixatign slaicmanl iden!iT�ed in 4Q CFR 2&2 27(aJ(d I am a large quanlliy gcAerakr}or{b)(if!am a smalr quantity gene�atoz)3a W e. <br /> Gonerakx'si(3ffernr's9dr Iedi typed Na g ,e Signahs NbrA Day Year <br /> �4 16.rMemaknal Shipments <br /> ❑import Io U.S- El Export fmm U.S Part a aril +em, <br /> z Transporrarsignature(for ekponso4y): gals!eav;gU-S.: <br /> of 17.Tampunel AcknvMW9T1en1 of Rncjmpt or Maledars <br /> a Transpprler1Prniedligpedr)amo Sgnalura fAnrh Day Year <br /> 7tan5Fc4er2p nledlTyued Nanla Signalum ftlh day Year <br /> r <br /> IS.Discrepancy <br /> I6a.O screpancy IndmNion Space ell,❑ flvantiry ❑Type ❑Residue Penial�ejaclinn ❑FF,11Re(atdOh e <br /> Ml-n+f2s[FL Ie erica Number, <br /> M.Akernate Faoldy(or Generalorl U.S.EPA ID NoTter <br /> J , - <br /> L11 Faahly's Phone, <br /> LU 18e.Slgnarurc a;Aikman FacRily for Gen mw) Month Day car r <br /> l9 Hazardous Waste Report Mariagerr,eni rnelhad Codes(F.e..nodes fur hazardous t4asla beMment,disposal,amd(L*Iing sysiems) <br /> 0 1 3. a <br /> 2i3.Dasrgn�dd FaGeity Cv nor o-r 4pgraior adikarlon of recelpr of bora c =rr8terpts gm eretl by the maniresl excepl as noted In I lea <br /> Pnglt lrTyped Narita Slgnalurz X1011 i] You <br /> mkkb- �� I �"k"A-S <br /> 1 <br /> EPA Form a701']-?2(Rev.12-177 Previous edifianS are ahSplEl2. „ , ,,_ , <br /> QFSI- F i',CIL!I r'TO EPA's E-irii�rv',rFE.T;3 �I Eci <br />