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Pleaseprrrll-or lype. <br /> UNIFORM HAZARDOUS t.Gene lar Number Form Appmved. OMB No.20E0.0039 <br /> WASTE <br /> 7 2,Page 1 W3.Emergency Response Phone 4.Manliest Tracfting Number <br /> MANIFEST1* � �f' 030010337 <br /> -} <br /> ff 1 800-535-5053-IHFOTRAC; 0 3 0 01 0 3 3 7 WAS S.Generarv�s Nanre and&},iiGrryAddlsss � � YU 1`i <br /> {� �� `l{{�� r••� ] is o �,},wa� r I�� s{d dllfewl Than mairog address} <br /> GanaralcesPhan e; <br /> 6.Transporter 1 Company rVanle <br /> CLEANTECH ENVIRONMENTAL MEN b ar <br /> 7.Transporter 2 Company Name CAL000330453 <br /> U. Ef R If]Humber <br /> &.❑esignaltd Faciity Name and Sdo Addross <br /> CLEANTECH ENVIRONMENTAL INC. U.S-EPAiONumber <br /> 5020 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 USA <br /> Faolfty's Phune: 626-812-7260 <br /> 4a. 'b-U.S.Df)TDes4ipElon{rr cICMg F mAerShipping Name,Hazard Class,llS Har dyer. <br /> HM and Parking Group brany)) 10-Canlainars t1.Total 1Z Unit <br /> f, Na. Typo Quanilly Mivoi. 13 Waste f titles <br /> �v tN --P——3S <br /> w Z IVOFV-RImmrlMZAC20005 WASTE SdLEf? (A6SQRgENTIPRPER <br /> c7 FILTER MEOIAJ � ^. OM P 352 --- <br /> 3, P eN- FSp{I Elll I-SOL-10-WA ElU5EB• <br /> METAL.-IL-EXTERS) --6M— <br /> 4 - <br /> 14-S j+¢tia!H�lino Inslruelio-ns aexJ Adduogar lnformsbaR <br /> 982)PROFILE r USE GLOVES ANO GOGGLES <br /> iiSFCLT]:• (PAPER FILTER) <br /> CALLER MUST]IDENTIFY CLEANTECH ENVIRONMENTALAS REGISTRANT: INFOTRAC 1300-535=5053 - <br /> 15. GF_NMTOR'SIOFFERGR'S CERTIFICATION;i hereby declare Ihat the CanlEnlS nt Ibis rnnslgnment aTa fully and aaeura4&e Cdbed ahane by the r»apershlpPing name,ardare Massrried,Paekagetl. <br /> marked and Fdheladypiacarded,and are in an r&VEafs n proper xindilion for traneppR acwreing la applicable fnlemmonal and naliarraf govern nen ai regu:aliuns.II a%poR step ren!and I am IhS P rmary <br /> �POFw,,I certify lhal the conlenis ei Ibis noP6ignment coalorm to lFe lawns of Che alWhed EPAAcKRo1v!¢dgmerrl of Consen! <br /> 1 oee*that the wasta mifrimiiation Maiemard idniii 4d in 40 CFR 262-�7(a)iia I am a Ialga quantity generalail or f ql{iii am a amal]gdanii:y genaralar)is true <br /> Generator srpfteror'g R in IadlTyped Na <br /> SignaWre <br /> r +PI I'Ir e—L.4 r T I f Sa illr pay Year <br /> J tG.Inlemarbnial Shvmeals <br /> ❑Impol la J.S- ❑Export from U.S. <br /> TAa of eatryya>il. <br /> ranaponer sfgrralura{lana%parts¢nHlt <br /> OG 17.TransporterACJnlovgeagmem of RCCe�p1 alMalCriBls Dale leswnq U,S• <br /> TranVDiler i Printadllyped Name <br /> a r 5ignalue <br /> fj Month Day Year <br /> 1Grt f. .� <br /> U) TransporCsr2 PriRC¢dlTypoo Na <br /> Signalurof hiurdh Day Year <br /> 18.f3is�epanCy <br /> Riscrepalrcy iRdiealian Space <br /> ❑ Ouanbly ❑Type ❑Residue <br /> ❑PaRial Rejection ❑Fu'{Rejection <br /> rs8b•Aflernale Facibly(or Generator) 4lanlfesl Refarenee Number: <br /> u <br /> uS.EAAID hfvmher <br /> a <br /> LL. Fachy's Phone; <br /> F1dc SignalweafRllernalaFacilily(orGeneratarl <br /> z <br /> om Day Year <br /> 19.Hazarttcus Waslc Hep¢tl Nanagemenl Afetllod codes(I.e., des forhaxald <br /> t ous vasle treatment,disposal,and recycling systems) <br /> 4 2 % y $ <br /> 4- <br /> 20 Designaled Facjrq OC•mer r op!uawr:crmicaodn of re i of naE2rd0d3 maledala covered by!hE rnarifesl MeLLnoln tfem]Tia <br /> PrintcdlFyp¢d Name <br /> ah r �h Sd3nature C��: <br /> EPA Form 8700-22(Rev.12-17) Praviousedaens are ObWele. Ye <br /> �� <br /> OESIC;NATED FACILITY TO EPA's a-;,IANIFCST SYSTEM <br />