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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Numb 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST LA►—t?On � ,� 1 1800-535-5053-INFOTRAC 020606829 JJ K <br /> 5.Generator's Name and Mailing Address `` Generators Site Address(if different than mailing address) <br /> SPEEDCO <br /> r,nn nnnillnn i <br /> n{!C r /wu►Lt�..� <br /> Generator's Phone: GA <br /> — y <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL CAL000399638 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 6.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLEANTECH ENViROMENTAL CAL000330453 <br /> 5820 MARTIN RD <br /> IRWINDALE,CA 91705 USA <br /> Facility's Phone: 626-812-7200 <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> t. NON-RCRA HAZARDOUS WASTE SOLID(ABSORBENTIPAPER FILTEF _ r4 _ P 352 <br /> 0 MEDIA)z 2. Y� <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions andditional Information <br /> 9B1PROFILE# 3(9 �350—Lo—1 9 <br /> (PAPER FILTERS) E=,, r "E, (R`:RE .FI!T—�==m�JSE GLOVES.AND GOGGLES <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONIVIENTAL AS 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 /> --ked and labeled/placarded, P proper P g pP 9 P P <br /> N�a�a����,and are in all respects.r. Guriu'liiuil fui%toffs Uit BCGuldill w a iicauie iniemaiionaiand naiionai overnmenial re uiaiions.if ex ort shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. ,� <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator 1f a small quant% e)a� or)is true. <br /> Generators/Off eror's Pri Ite /Typed Name 76e Mo th Day Year <br /> j 16.International Shipments : <br /> ❑Import to U.S. ❑Export from U P of entry/exit: <br /> ? Transporter signature(for exports only): to leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLJTransporter ame Signa r <br /> 1 Printecirryped e Month Day Year <br /> CL <br /> Z Transporter 2 Printed/Typed Name Signa tu c Month Day Y r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue El Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> H 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Re rt anagement 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 Oper :Certification of receip f h zardous materials covered by the manifest except as noted in Item <br /> Printedrfyped Name 6wUD . Signature `_ MEn <br /> Year <br /> 1(�JlAF_11 ("J�� <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIG ED FACILITY TO EPA's e•MANIFEST SYSTEM <br />