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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Num r 2.Page 1 of 3-Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST 1 800-535-5053-INFOTRAC 030005028 1NAS <br /> 5-Generator's Name and Mailing Address Q Lr�r �o>�e Address(if differ an m��ilfnr s <br /> __g adds] <br /> Generator's Phone: fl A C145'30(0 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000399638 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8-Designaled Facility Name and Site Address U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000330453 <br /> 5824 MARTIN ROAD <br /> IRWINDALE,CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> ga 9b.U.S.DDT Description{including Proper Shipping Name,Hazard Class,ID Number, 10.Contalners 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No, Type Quantity Wt-Nol. <br /> 1. 149N RGRA 1 T,, DM- P 352 <br /> ra; <br /> 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER 5111^ P 352 <br /> LU <br /> 0 FILTER MEDIA) <br /> 3- T re�c [ S 352 <br /> METAL 911 FILTERS) I <br /> 14.Special Handlinq�insbmcfions and Additional Information 2 7 <br /> ^""^^ �" ^ 9B2]PROFILE#;30��'�`�� [ USE GLOVES AND GOGGLES <br /> (PAPER FILTER) 983) (MET,0�r_�ctrT=FRS� <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 cons'sgnmeni are fully and accurately described above by Iue proNr shipping name,and are classified,packaged, <br /> marked and tabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental reg 'ns.If export shipment and 1 am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I eedify that the waste minimization statement identified in 40 CFR 25227(a)(if I am a large guanlity generator)or(h if I am a small quanlity g er r)is true. <br /> Generator slOfferor's PrintedlType me SI &Tm- Month Day Year <br /> tv"qL Isis lick <br /> _j 16.International Shipments - <br /> ❑Import to U-S. ❑Export from U.S• Port of enlry it: <br /> E Transporter signature(for exports only): Date leaving U.S.: <br /> X 17.Transporter Acknowledgment of Receipt of Materials <br /> rsr <br /> Transporter 1 Printed/Typed Name 5 Month Day Year <br /> d <br /> z Transporter 2 Printedi Typed Name Signa ur Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑ResidueEl j le <br /> Partial Rejection Full Re' Ilion <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> [.7 <br /> LL Facility's Phone: <br /> stir 18c.Sig nalure of Alternate Facility(or Generator) FlIenth flay Year <br /> d <br /> y19-Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyding systems) <br /> p 1. 2. 3. 4. <br /> Ak <br /> 20-Di 6gnaled Facility Owner or 0 or:Certification of receipt a zardous materials covered by the manifest except as noted in I A183 <br /> PrintedfTyped Name �ny Signature Month Day Year <br /> SSV ° l4 ba C} �1r 1 <br /> EPA Form 8700.22(Rev.12.17) Previous editions are obsolete- 0 SI NATFD FACILITY TO EPA's 0-MANIFEST SYSTEM <br />