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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 14,Manifest Tracking Number Q <br /> WASTE MANIFEST � >Q��?rj' z 1 800-535-5053-INFOTRAC 03000541-7 WAS <br /> 5.Generator's Name and Mailing Address SQ ee_J Lo *_ lam; Foie tor's Site Address(if different than mailing address) <br /> Geneeralol (115,31"t, <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 /> S.Designated Facility Name and SileAddress U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 USA <br /> Fact lily's Phone: 626-812-7200 <br /> ga 9b-U.S.DOT Descripton(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(if any)} <br /> Na. Type Quantity wt./vol- <br /> 1 EUASSQRBENZ _.DM___- _ .._ P 352 i <br /> 0 �..._ <br /> rr <br /> 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> LU <br /> FILTER MEDIA) <br /> N9— 52 <br /> MET�916 cii Trac) _ <br /> 4. <br /> i <br /> g4/ 44 <br /> ' I <br /> 14.Special Handlin�lnstruclions and Additional Information <br /> -9��} EE# 982)PROFILE USE GLOVES AND GOGGLES <br /> (PAPER FILTER) �R1T_ <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTALAS 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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulatior}s.If export shipment and i 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 /> t certify that the waste minimiralfon stalentenl identified in 40 CFR 262.27(a)(if I am a large quantity qeneialorlxbX1177FT II quantily gen i5.1 <br /> Generator slofferors PrintedrTyped a Si re r Month Day Year <br /> _j K Inlema bnal Shipments <br /> F ❑Impod to U-S- ❑Export from t),.91� Port of enlrylexi <br /> Z Transporter signature(for exports only); �� Dale teaving <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLI <br /> 1,- Transporter 1 PrintedrTyped Name gnature Month Day Year <br /> 0 Transporter 2 P IedlTyped Name Signature Month Day Year <br /> l <br /> F- <br /> 18-Discrepancy <br /> 183,Discrepancy Indication Space ❑ Quanlily ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b-Altemate Facility(or Generator) U-S.EPA ID Number <br /> U <br /> rdi Facility's Phone: <br /> LLE 18c.Signature of Allemate Facility(or Generator) Month Day Year <br /> 2 <br /> 0 <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatmeal.disposal,and recycling systems) <br /> C3 1. 2. 3- 4, <br /> I <br /> 20,Desognaled Facility Owner or Opera r:Certification of receipt of IMIFdous materials covered by the manifest except as noted in Its 8a <br /> r�� <br /> ped Name Signature Ivlonl ay,DYe r <br /> . 6N_�A I �� I - ,"W�) �� I <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESI N TED FACILITY TO EPA's i?-MANI FEST SYSTEM <br />