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Please print or type. Form Approved,OMB No.205HO39 <br /> UNIFORM HAZARDOU5 I I-Generator ID Number 2-Page 1 of 3.Emergency Response Phone 4,Manifest Tee uking Number `�{r <br /> WASTE MANIFEST a� 3 1 800-535-5053-INFOTRAC 030015573 l�l�AS <br /> b.Generators Name and Mailing Address t `,� L k q, f�, — Ge ralo�s Site A ss if dere an mailing address) <br /> Generalor's Phone: I r <br /> 6.Transporter 1 Company Name U,5.EPA ID Number <br /> CLFANTECH ENVIRONMENTAL INC. CAL000399638 <br /> 7,Transporler 2 Company Name U.S.EPA ID Number <br /> 8.Deslgnaled Facilily Name and Site Address CLEANTECH ENVIRONMENTAL INC. U.S.EPA ID Number <br /> 5820 MARTIN ROAD CAL00033U�53 <br /> IRWINDALE,CA 91706 USA <br /> Facillty's Phone; 626-812-7200 <br /> ya 9b.U.S.DOT Descriplion(including Proper Shipping Name,Hazard Class,ID Number, 10.Conlainers 11-Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No- Type Quantity wt.Nol. <br /> D <br /> Q I I <br /> 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER Lf,1 P 352 <br /> LU <br /> FILTER MEDIA) _ <br /> 8 1200 <br /> 3---NON-RCRA-HAZ-A.RDOUS-WASTE-SOLID-(OILY-SOL-ID WASTEIUSED _ --,DM - — P 352 <br /> METAL-DIL-FILTERS) <br /> 4 <br /> 14.Special HandlinInstructlons and Additional Information <br /> 913-1)-PRUILE#- — 962]PROFIL USE GLOVES AND GOGGLES <br /> ---+AB&oRBENT-}—_— (PAPER FILTER) (MET-A6 F;LTLa4)— <br /> CALLIE R MUST IDENTIFY CLEA NTEC H ENVIRONMENTAL AS REGISTRANT; INFOTRAC 800-535=5053 <br /> 15. GENERATOR'SIOFFEROR'5 CERTIFICATION: I hereby declare that the content%of this cormlgnment are fully and accurately described above by the proper shipping name,and aro classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper conditmn for transport according to applicable international and national governmental regulalions.If export shipment and I am the Primery <br /> Exporter,I certify that&contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minirnizaliun statement idenlified to 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a s II quantity generator is Ime. <br /> Generator'slOHeroes Print dlfyped Name Signature Month Day Year <br /> �!{ f a . <br /> 16.Intematianal Shipments <br /> F ❑Import to U-S. ❑Exporl from U.S. of enlrylexil: <br /> E Transporter sigma lure(for ex pals only): Date leaving U.S.: <br /> LC t7-Transporter ACknowiedgrnenl of Receipt or Materials <br /> LU <br /> Trans or! 1 PrinledfTyped Na Signalure Monlh 'Jay year <br /> 0- SCSI ,? �. <br /> - 7 _, <br /> 2 Transporter P edflyped Name Signature Month Day Year <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑-type 1 <br /> El Residue Partial Rejecloon Full Re action <br /> Manifest Reference Number <br /> 18b.Allemale Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Faculty's Phone: <br /> W 16c-Signalure of Allemale Facility(or Generator) htonlh Day Year <br /> a <br /> 19.Hazardous Waste Report Management Method Godes(i.e.,codes for hazardous waste trealmenl,disposal,and recycfng systems) <br /> � 1. 2. HR � 3 4. <br /> 20,Designated Facility Owner or Operat Certification of receipt of hazar us malerlals covered by the Manifest except as noted in Item 18a <br /> PrintadlTyped Nerve � 1 1..., �` Signature MonthDayY r <br /> EPA Farm 8700.22(Rev.12-17) Previous edilions are obsolete. �V DESIGNAT FACILITY TO EPA's e-MANIFEST SYSTEM <br />