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Please print or type. Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.ManifestTracking Num6er WA <br /> [� <br /> WASTE MANIFEST C Pt�s,�o�33 4 7 -7 1 800-535-5053-INFOTRAG 0 3 0 0 0 5 3 8 0 Y AS <br /> 5-Generators Name and Mailing Address ��j n G• Ge a sOAVbd Vif different than mailing address) <br /> Generator's Phone: rr-� C:1� L-� ■�`��� <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,Dasignated Facility Name and Site Address U-S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. <br /> 582D MARTIN ROAD CAL00033D453 <br /> IRWINDALE,CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> 9e 96.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, �10-Contai,ers 11.Total rV.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) Type Quantity <br /> I- 52—t <br /> � ! I <br /> 0 <br /> 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER DM P 352 <br /> FILTER MEDIA) <br /> 3. 1-4B—(QlP(-&0WD4ASTE/USED -DM — -P- —362- <br /> ME= <br /> 362-ME= nn FII TFRS) _ --- <br /> � 1 <br /> i <br /> 4 RC Sc,1 i j PIWk-10-wr <br /> pa9 e— fi jk r �iG <br /> 14.Special Flandlin Instructions and Additional Information <br /> R4L-E -- 9132]PROFILE#P' �' J USE G,• G GLES r �_ <br /> (PAPER FILTER) 9 Z ce��Tarsrr Trod <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTALAS REGISTRANT: INFOTRAC 800-535=5053 <br /> 15- GENERATGR'SIOFFEROR'S CERTiriCATIDN: I hereby declare that the eonlents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded.and are in all respects in proper condition for transport according to applicable inlernalionat and national governmental regulations.11 export shipment and I am the Primary <br /> Exporter,I cerlify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consenl. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)or(b)(if I am a small quantity gener8tcr)is true- <br /> Generator Offerors Printed/Typed Name, Signature Month Day Year <br /> .Interna onal Shipments <br /> ❑Import to U.S. Export from U.S. Port of env lexil: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> tr 17-Transporter Acknowledgment of Receipt of Materials <br /> ut <br /> Transporter 1 PrintedlTyped Name ature Month Day Year <br /> Z-9 IC( <br /> Z Transporter PAnW/Typed Name sig ure Month Day Year <br /> t- <br /> 18-Discrepancy <br /> 18a,Discrepancy Indication Space Quantityy <br /> ❑T pe ❑Residue Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b-Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Facilily's Phone: <br /> C3 1Be.Signature of Allemate Facility(or Generator) Month Day Year <br /> a <br /> 19-Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste Ireetmenl,disposal,and recycling systems)LU ` <br /> 0 1. 12- 3 4 <br /> 20-Designated Facilily Owner or Operator:Cep7kafion of receipt of hazwd9ds—alplerals covered by the manifest except as noted in Item 188 <br /> PrintedlTyped Name Signature Month Day Year <br /> I r I LCMA�"u . �k I n[ o <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNIAT D -ACILITY TO EPA's 0-MANIFEST SYSTE-Mi <br />