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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Num 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST 1 900-535-5053-INFOTRAC 1 02060688 JJ K, 5.Generator's Name and Mailing Address ` �`LlU Generators Site Address(if different than mailing address)5 DQ r �0 SPEEDCO`tjCEn �w. Vl 1 nnnn Rnp.tnnr, AVF(� a L�u T r. _ 7 USA 7Cin. Generator's Phone car=r-�� S3(1 6.Transporter 1 Company Name U.S.EPA ID Number CLEANTECH ENVIR011RENTAL CAL000399638 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number CLEANTECH ENVIROMENTAL 5820 MARTIN RD CAL000330453 IRWINDALE,CA 91705 USA Facility's Phone: 626-312-7200 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. NON-RCRA HAZARDOUS WASTE SOLID(ABSORBENT/PAPER FILTE, Cf,4 P 352 MEDIA) Ll w Z 2. i_ yry-7n n Q IAp2 r- enr Irl(ARBS0R8E11ITlPAPF - n L r�I�r F��e �� L T- -a-�u-T.F --P----a��z--- 3. 4. 14.Special Handling Instructions and Additional Information 9B1PROFILE# ��'�?) I> 1 �?62)PF;LG-t6Et` (PAPER FILTERS) (METAL FILTERS) FRG) SE GLOVES AND GOGGLES TANKER# CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(iil am a small quantity generator is true.' Generator's/Offeror's Printed/Typed Name Sig ure- Month Day Year SSE �� - �� z n 16.International Shipments E- ❑Import to U.S. ❑Export from III Port of.try/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials UJ Transporter 1 Printed/Typed Name ature Month Day Year CL i Z Transporter 2 Printed/Typed Name Si a Month Day Year j � rr 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity Type j ❑ El Residue Partial Rejection Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number V Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 55 19.Hazardous Waste Rep rt Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. 20.Designat d Facility Owner or Operator:Certifi tion of receipt of hazardy0s materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year 6\�-\) 11-� I U��b, ova k)W \0 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNAT FACILITY TO EPA's e•MANIFEST SYSTEM