Laserfiche WebLink
Please prim or type. Form Approved.OMB No,2050.0039 <br /> UNIFORM HAZARDOUS 1 enerator ID Number 2.Page 1 of a.Emergency Response Phone R.IManilest Tracking Number <br /> WASTE MANIFEST �(3 1 800-535-5053-INFOTRAC 030025658 NAS <br /> 5.(Generalars Name and Mailing Address C �a;a r NON Y dlerenl than maliing address) <br /> +.Cd," 'I��OIo❑ s ��'f r did <br /> Generator's Phone; C T <br /> 6.Transputer 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC- CAL00D399538 <br /> 7.Transporter 2 Company Nama U.B.EPA ID Number <br /> 8,Designated Facility Name and Site Address CLEANTECH ENVIRONMENTAL INC, U.5.EPA IO Number <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE, CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> ga. 0b.U.S.DOT Description(including Proper Shipping Nama,Hazard Class,to Number, 10.Canlainers n.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Typ 0uanilly W1JVol- <br /> /+rHAYIARE) R -iMfXSF$-59LH 52 <br /> w 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER DM P 352 I <br /> t7 FILTER MEDIA) +— <br /> 3�i�LJbI.F�Ck�.ArkiA�.44�9DI��L1lA�E��Lib--�L]lL <br /> - ETH GI FILTERS) <br /> 1� I-- <br /> 4 II <br /> IL <br /> 14.Speclal!Handlin�insiructions and Additional Informalion , <br /> `--9lsroFrft 982}PROFILE#- USE GLOVES AND GOGGLES <br /> —�ADZ>UKULIV 1) (PAPER FILTER) X33 nncr�i crr7coct <br /> CALLER MUST IDENTIFY CLEANTECH ENV{RONMCNT'AL AS REGISTRANT: INFOTRAC 800-535=5053 <br /> 15. GENERATOR'S)OFFEROR'S CERTIFICATION: I hereby deelare that Ile contents of Ibis consignment are fully and accuraleiy described above by the proper shipping fame,and are classified,packaged. <br /> marked and labeledlplacarded,and are in 0 respects in proper condition for transport according to applicable International and national govemmemal reg ulatlons.if export shipment and I am the Primary <br /> E aporter,l certiry Itsal the contents of 1%cerlsigr ineal conform Iv the lerms of lice aflacbed EPA Acknowledgment of Cvnsenl. <br /> I certify that the waste minimization slatement idanhfied in 40 CFIR26227(a)(if I em a large quantity generalal)or jb)(if I am a small quantity generator)is true. <br /> Gerreralor`90Heror5 Priniedfryped Name Signature htanlh pay Year <br /> __j 16-lntemabonal Shipments <br /> % ❑ImporltoU.S. ❑ExportfromU.S. Port ol entryleft _ <br /> Z Transporter signature(for exports only); Date leaving U.S.- <br /> W IT TransportarAcknowledgmeni of Receipt of Malerials <br /> T sender 1 Prinladffypad Sigaalrrre Mwith Day Year <br /> ;;" <br /> Transporle PnnledlTyped Name Signalure Month Day Year <br /> r- <br /> 1 B.Discrepancy <br /> 18a.Discrepancy Indicalion Space Quanlily ❑Type ❑Rasidue Partial ReI ection <br /> Full Rejeelion <br /> Manlfesl Reference Numt�ar. <br /> 18b.Allemate Facilily(❑r Generator) U.S.EPA ID Number <br /> U <br /> Facility's Phone- <br /> w 18c.Signature olftroate Focillly(OFGenerBfor) Month Day Year <br /> a <br /> 19,Hazardous Waste Repart Management Method Codes(i.e.,podes for hazardous waste Ireatment,disposal,and recycling systems) <br /> � f. 2. � 1A3. A. <br /> 20.Designaled Fadilty CWner or Operator.Cedikration of re fpl of hazardous materials covered by the manliest except as np1rd in Item 1Ba <br /> PAnledlTyped Nama k Signature Day Ye r <br /> 4jt�l-t,b .��M T <br /> EPA Farm 8700-22(Rev.12-17) Previous editions are obsolete, SIS; }ATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />