Laserfiche WebLink
Please print or type, Form Approved.OMB No.2659.6D39 <br /> UNIFORM HAZARDOUS 1-GeneralorfD Number 2.Page i o[L3-:Ernefgeaccy Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST - �(��� 020022781 J JK <br /> r^ <br /> 5"GeneraEoa s Name and Plaiting Address ener tor' 5 e s if dr'lle l than mailing address) <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U"S.EPA ID Number <br /> CLEANTEC-i ENVIROMENTAL CALOOD309638 <br /> 7 Transporter 2 Company Name U.S"EPR 10 Number <br /> 8,Designated Padifty Name and Site Address <br /> U.S.EPA ID Number <br /> CLE4NTECH ENVIROMENfTAL <br /> 5820 MARTIN Ra CAL000330453 <br /> IRWINDALE,CA 99705 USA <br /> Faeililys Phone 620-812-7200 <br /> ga 9b.U"S"DOT Descripllon{including Proper Shipping Name,Hazard Class,10 Number, 10,Containers 11.Total 12,Unit <br /> HM and Packing Group{f any)) 13"Waste Codes <br /> No" Type RuanGly WI.IUol. <br /> 1' NON-RCRA HAZARD 0US WASTE SOLID(ABSORBENT/PAP ER F I LTEI P 352 <br /> NiEt71R) _ r <br /> F�OD <br /> I I <br /> uj <br /> LU <br /> S s nnnr tc Jnr r r- r.r- <br /> 3. 4e R8 R,-.1 —Fl —-352—•I.— ..� <br /> 4" J <br /> I <br /> 14, <br /> Spedal Handting Instruction J n f rm lion <br /> 8B9PROFII Ei� : rir Q-. 2-17 PUSE GLOVESANDGOGGLESTANKER,' <br /> (PAPER FILTERS) ^a R sE.'�P--- <br /> CALL ER MUST IDENTI>=Y CLEANTEC[A E IVIRONNIENTAL AS RLGISTRAS J f;INFOTRAC 800-535-5053 <br /> 15. GE N ERATOR'WOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accuralely described above by the proper shipping name,and are classified,packaged, <br /> mar'aed and Jabeledlplacarded,and are in all respects in proper condaion for transport accoiding to appficebfe intematiorraland national governmental regulations.If expel shipment and I am the Primary <br /> Expoder,I certify Thal the contents of this consignment conform 10 lite terms of the attached EPAAckncwfedgment of Consent. <br /> I certify that the waste minimixalion statement identrhed tri 40 CFR 262-2T(a)(if I am a large quantity generator)or(b)(if I am a small quantity generatorps true. <br /> GeneratorslOfreror's PrtntedfTyped Name r r' Signalure -- -r hlonlh Day Year <br /> .._ 'ice. ,� . r "! rr J•. <br /> LO 1 <br /> 16.1nlernalional5hipmenls r <br /> F �• ❑Import to U.S. ❑Export Pram 11,5. y Port oferiirylexit: <br /> ? Transpoder signature(for exports onlyy Date leaving U.S.: <br /> w 17.TransporterAcknmvledgmen(of Receipt of Materfals <br /> Transporter I Prinledfryped Name Signal a ftonlh pay Year <br /> 0 _ <br /> 2 U) <br /> Transporter 2 PrinledfTypad-T4ame Signature G.onth Day ear <br /> t-- <br /> 1 a.Discrepancy <br /> laa"Discrepancy lndicMion Space quantity ❑Type ❑Residue ❑Partial Reyeclion ❑Full Rejection <br /> Manifest Reference Number: <br /> ti 18b.Allernale Facilily(or Generator) U"S,EPA ID Number <br /> J_ <br /> Facility's Phone: <br /> LLF 180.Signature of Alternate Facility(or Generator) f lonlh Day Year <br /> d <br /> a <br /> 0 19.Hazardous Waste Report Management Method Codes(i"e.,codes for hazardous waste treatment,disposal,and recycling syslems) <br /> 0 1. 2. 3. :I==- <br /> 20 <br /> � \ — <br /> Desfgnaled Facility Or'rner or Opera :Cedlflcatron of receipt of ha ardous matelots covered by ifre manifest except as nded in Item <br /> Printedffyped Name to Signature pl,. lr Dk Year <br /> EPA Form 8700.22(Rev.12-17) Previous edRions are obsolete. DESIGN Ja I ECJ FACILITY TO EPA'S e--hlANI F ESI S111 STEM <br />