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Please print or type. Form Approved.OMB No.2050.4039 UNIFORM HAZARDOUS1•Generator If}Number 2,Page 1 of .Emergency Response Phone C Manifest Tracking Number WASTE MANIFE57 ��t43 3 1 800-535-5053-1NFOTr'RAC 030025676 WAS 5.Generator's Name and Mailing Address Gen ors ite�d ["int 8j mailing address] �rG 6.Transporter 1 Cam pany Name U.S.EPA IU Number CLEANTECH ENVIRONMENTAL INC. CAL000399638 7 Transporter 2 Company Name U.S,EPA 10 Number 8,Designated Facility Name and Si le Address U. EPA fl)Number CLEANTECH ENVIRONMENTAL INC- CAL4DD330453 5820 MARTIN ROAD IRWIN❑ALE,CA 91746 USA Facillty's Phone: 626-812-7204 ga, 9h-U.S.DOT Destxtplion(including Proper Shipplrng Name,Hazard Class,i0 Number, 10.Containers 11.Total 12,Unit 13.Waste Godes HM and Packing Group(if any)) No. Type Quanlity wl Not. SSOLIL� {{iJ5F�0.A8SQ&BENT — —DM - p w 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER DM P 352 C7 FILTER MEDIA) 3. LIE) —.DM--._ P- e16 FWTERS)- 14.Special Handlin Instructions and Additional Information 8132}PROFILE USE GLOVES AND GOGGLES (PAPER FILTER) CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535=5053 15. GENERATOWSIOFFEROR'S CERTIFICATION:I hereby declare Ihal the contents of[his donsigoment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labetedlplacarded,and are In all respecls in proper condition for transport according la applicable intemalional and nalionsl governmental regulations_If export shipment and I aryl the Primary Exporter,I certify that the contents of this consignment conform to the lerms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization slalement Identifled In 40 CFR 262.271a)(III am a large quantity generator)or(b)(if I am a small quantity generator)is We. Generator'slOffe f's P drr ped Na Signa (Month Day Year & Ccl ,j 16:11rilernalional Shiprnflols Impart to U-s_ ❑Export from U_5. Port of entrylexil. 9 Transporter signature(for exports only): Date leaving U.S.: w IT.Transporter Acknowledgment of Receipt of Materials Tran rtar 1 PdnledlTyped Name signalufe Month Day Year CL 4 •G aTransporler 2 Print yped Name Signature Month Day Year 18.Discrepancy 18a-Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejeclion ❑Full Rejection Manifest Reference Number; r} 18h,Alternate Facility(or Generator) U.S.EPA ID Number J_ L) if Facility's Phone: Lu 18c,Signature of Altemale Facility(or Generator) Monfi1 pay Year Q N1 R.Haxarddus Wasle Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. / r 3. 4. 20.Qwgnaled Facility Owner or Q r lar.Certification of receipt haazardous maledals covered by The manifest.except as Fidt in I[am 1B Printed/Typed Name S Signature v Month Qa Year tb EPA Form 87DO-22(Rev.12-17) Previous editions are obsolete, }ESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM