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Please print or type, Fora Approved-OM13 No,2050-0039 <br /> UNIFORM HA7ARDOUSI Generator ID Number 7.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number x <br /> WASTE MANIFEST �J00 3 �y � 1 800-535-5053-INFOTRAC 030025614 WAS <br /> 5.Genaramr's flame and Mailing Address �r ' different Than mailing address) <br /> � 4�1+� <br /> Generators Pho-ne: <br /> 36 <br /> 8.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CALOOD399638 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> S.Designaled FacNily Name and Site Address U.S.EPA ID Numb6i <br /> CLEANTECH ENVIRONMENTAL INC. CAL000330453 <br /> 5820 MARTIN ROAD <br /> IRWIN❑ALE, CA 91706 USA <br /> FadlWs Phone: 626-812-7200 <br /> ga. 9b.U.S.007 Descriplim(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if anyy) No. Type 0020ty WI.N01. <br /> I _3r <br /> a <br /> F- -- —. .. <br /> 9 <br /> Liu 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER DIMP 352 <br /> tD FILTER MEDIA) J_ <br /> {� Zv <br /> res- SOLID vvasFEA48E-D- DIN! <br /> —M <br /> a. <br /> 1�SpecialHandlin Instn,claansandAdditional infomlion r <br /> rz� r< 962}RRQPILE# USE GLOVES AND GOGGLES <br /> {PAPER FILTER} IL—TERS-} <br /> CALLER MUST IDENTIFY CLEANTECH EN VIRONMENTAL AS REGISTRANT: INFOTRAC t300.535=5053 <br /> IS. GENERATOR'SIGFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and amuralely 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 international and national governmental regulations,lrexpDrl shipmant and I am the Primary <br /> bponar,I eerlify that the contents of this consgnmem conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify lhal the waste minimization statement rd8offied in 40 CFR 28227(a)(if I am a large quantity generator)or lb)(if I am a sniall quantity gen tor)is true. <br /> Generallor'slO�fferor's PdiiKdlTyped Name Signature Monlh Day Year <br /> 16.IntmaUcmal Shiprpents l�I <br /> 0 Import to U.S. L_1 ExportWTS. Port of entryyexil <br /> ? Transporter signature(for exports only): Lata leaving U.S.- <br /> Pe w 17.Transporter Acknowledgment of Receipt of Materials <br /> Tran rfer 1 PrintedflrPed Name Signature Month Day Year <br /> 0 q v V u+rti Z ' <br /> Z TranspoftrIbPrinWyped Name r Signature Month Day Year <br /> f- <br /> 18 Discrepancy <br /> 18a.Discrepancy Indication Space Gjamay ❑Type ❑Rpsidue ❑Aarhat Rejection ❑Full Re coon <br /> Manifest Reference Number. <br /> ISb-Alternate Facility far Generalor) U.S.EPA ID Numher <br /> i] <br /> Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) MG01 Day Year <br /> a <br /> a <br /> N19-Hazardous Waste Reporl Managemenl Method Codes(i.e.,codes for hazardous waste Treatment,disposal,and recycling syslems� <br /> 1, 2. 3. 4. <br /> :W:q <br /> 20.Deslgnaled Facility Owner❑ Dperator.Cisdirication of recei pi azardous materlals covered by the manlfest except as ed in Item 18a <br /> Pnntedrryped Mame Signature M th Dn Ye <br /> C 1, � , 1 � . <br /> EPA Form 8700-22(Rev,12-17) PrObbs editions are obsolete. ESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />