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Piease print or type. Form Approved.OMB No.2050-GO39 <br /> UNIFORM HAZARDOUS 1.Gernera(or iD Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST .� 020022889 J J K <br /> 5.Generators Name and Mailing Addre � f; Ge rotor' SI(e Ad s if dime nt than mailing address) <br /> ZT <br /> L <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA 10 Number <br /> CLEANTECH ENVIROMENTAL CALD00399638 <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> 8.Designated Facility Name and Site Address U-S-EPA tD Number <br /> CLEANTECH ENVIROMENTAL <br /> 5820 MARTIN RD CF�LDI3433053 <br /> IRWINDALE,CA 91705 USA <br /> Facility's Phone:626-812-7200 <br /> ga 9b-U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10-Containers 11.Total 12.Unit <br /> Hak and Packing Group(if arty)] No. Type Quantity WI.Nol. 13.Waste Codes <br /> 1• NON-RCRA HAZARDOUS WASTE:SOLID{ABSORBENTIPAPER FILTE P'" P 352 <br /> vF MEDIA) <br /> a <br /> rr <br /> LU <br /> Z 2. a nnRAP <br /> cwa _MEz; ', 016 F-1 µEnc. I <br /> 3. _ �AASTPE;OL - <br /> Pc' RGRA Hr.- R901IS anA8T-E•80 In <br /> I <br /> 14.Special Handling Instructions d t�rma on <br /> 9BIPROFILE# 5 �, - a 94�f�iI=lt- #— <br /> (PAPER FILTERS) iME:F , F"T-��; 3E -_-..._ __GLOIII*SAN❑GOGGLES TANKERdl-:19- <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: iNFOTRAC 800-535-5053 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATiON: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are Classified,packaged, <br /> marked and Iabeledlptacarded,and are in all respects in proper condition for transport according to applicable international and national go rVen4 <br /> 1 regulations.If export shipment and I am the Primary <br /> Exporter,I certify that(he contenls of this consign men[conform to the terms of the attached EPAAcknowled Consent- <br /> I certify(hat the waste minimization statement identifted in 40 CFR 262.27(a)(if I am a large quantity etor)or( (if I am a aII an r)is We. <br /> GeneratorslDHeror's Prillryped me Signature Month Day Year <br /> J 10 71 nlemstional Shipments <br /> ❑Import to U.S. ❑Export fro .s. P of entrylexil: <br /> ? Transporter signature(for exports only): ate leaving U.S.: <br /> W17.Transporter Acknowledgment of Receipt of Materials <br /> k— Transporter 1 Prinledffyp Name Signature Month Day Year <br /> CL <br /> OV Transporter 2 PrinledfTyped Name Signature Month Day ear <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej j <br /> Partial Re ection Full Rejection <br /> Manifest Reference Number: <br /> 186,Attemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> - 11 <br /> LU 18c.Signature of Altemale Facility(or Generator) ManBt pay year <br /> 4 <br /> 19.Hazardous Waste Report Yanagement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> wa 1. 2. 3. n. <br /> 20.Designated Facility Owner 6r Opera r.Certification 01 receipt of ha s materials covered by the manifest except as rrded in Item 18a <br /> Prnledffyped Name �n Signature M th DIV Ypar <br /> 7 !J . ;J c1ft <br /> EPA Form 8700.22(Rev,12-17) Previous editions are obsolete. DESIGNA11 FACILITY TO EN IFEST Y5 f M <br />