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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.Manifest Tracking Number {�, Q <br /> WASTE MANIFEST ['.A t—QC7p LA 33 4 7 7 1 800-535-5053-INFOTRAC 030015604 VYAV <br /> 5.'GGe/neralor's Name and Mailing Address }}C U If N&t Qq �enetoes Sil'�r� {if different than mailing address) <br /> Generalo s Phone: r Ql� CP17 C17C5 3 U <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,Designated Fact ity Name and Site Address U.S-EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000330453 <br /> 5820 MARTIN ROAD <br /> IRWINDALE,CA 91706 EISA <br /> Facility's Phone: 626-812-7200 <br /> ga. 9b-U.S-DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12-Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No- Type Quantity WUVOI. <br /> 1. - <br /> la—(USED ABSQRBEiV� _ --- DM_ _ _- _-.------P— .-352 `. —II..... <br /> 0 I 1 <br /> 2 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER C) P 352 <br /> FILTER MEDIA} ) <br /> 3. AR691�S�11rs T-F—9H I DM —.P--352—�— <br /> METAL OIL FILTERS) <br /> 4- <br /> 14.Special Handling Instructions and Addilional Information <br /> 9B2]PROFILE# USE GLOVES AND GOGGLES <br /> (PAPER FILTER) S~ <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535=5053 <br /> 15- GEN ERATOR'SIOFFERQR'S CERTIFICATION: I hereby declare That the mnlents 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 regulations.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 Acknativledgmenl of Consent <br /> I certify that the waste minimization stalement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Gen tor'slOfferors Printedlryped Name Signatu Month Day Year <br /> 16-International Shipments Impart to U.S. <br /> ii, Export from U.S. Port of enlrylexiC <br /> ? Transporter signature(for exports only): Date leaving U-S-: <br /> W 17.Transporter Acknowledg ment of Receipt of Malerials <br /> LU <br /> Transporter i Printed[Typed Name 1 re , Month Day Year <br /> 0. <br /> Transpo ter 2 Printedffyped Name Signalure Month Day Year <br /> 1 B.Discrepancy <br /> 1 Sa.Discrepancy Indicalion Space Quantity ❑Type <br /> ❑Residue El Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) 11.5.EPA ID Number <br /> Zi <br /> 0 <br /> �E Facility's Phone: <br /> eLu I8c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 19-Hazatdous Waste Report Management Method Codes(i-e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20-Designated Facility Owner or Operator Certification of receipt of hazan maIrfals covered by the manifest except as notd in em 18a <br /> PantedlTyped Name Signature Month Da Year <br /> EPA Form 8700-22(Rev.12-17) Previous a (tions are Obsolete. E IGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />