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Please print or type. <br /> Form Approved.OMB No.2050-0039 <br /> FGeoerator's <br /> ZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number ,A,/� <br /> NIFEST ��L L�� JCI ��� 1 <br /> f[8 53 010 8 6 3 YY/is <br /> me and Mailing Address Generator's Site Address(if different than mailing address) <br /> '3 Cce {(c IZt�ij <br /> C'v 1 <br /> ( ' ( 5 HG y%tfL, <br /> GE, , <br /> ' Phone: �A I)(,t 1 C(� c��j 9'U;J�• <br /> er 1 Company Na e <br /> U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL CAL000330453 <br /> er 2 Company Name <br /> U.S.EPA ID Number <br /> d Facility Name and Site Address <br /> CLEANTECH ENVIRONMENTAL INC. U.S.EPA ID Number <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE, CA 91706 USA <br /> one: 626-812-7200 <br /> U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes <br /> No. Type Quantity Wt.Nol, <br /> 11= 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> Z 2. NO <br /> N-RCRA <br /> WHAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM., P <br /> c7 FILTER MEDIA) 352 <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED T } P 352 <br /> METAL OIL FILTERS) ,� <br /> C m 3o, <br /> t <br /> 4. <br /> i <br /> 14.Special Handling Instructions and Additional Information <br /> 9131) P 9B2)P USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535=5053 <br /> 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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27 (if am a large quantity generator)or a small quantity generator)' rue. <br /> Generator's/Offeror's Printed/Type Name Sign re <br /> Mfonth Day Year <br /> J 16.International Shipments <br /> Z ElIm U.S. ❑Export from U.S Pori of entry/e . <br /> Transporter signature(for exports only): Date leav' U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> F- Transporter 1 Printed/Typed Name Signatu <br /> O /� 7_17_6 <br /> Month Day Year <br /> Z Transporter2 Printed/]yped Name Si re <br /> Month Day Year <br /> f- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑ <br /> Full Rejection <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number: <br /> J U.S.EPA ID Number <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) <br /> Q Month Day Year <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU <br /> 1 12. 3. <br /> 410 4. <br /> 20.Designs ed Facility Owner or Operator:C ification of receipt of hazardous materials covered by the manifest except as not in Item 18a <br /> Printed/Ty e Name Signatu <br /> Ith <br /> EPA Form 8700-22(Rev.12-17) Previous a ions are obsolete DESIGNATED FAC ltiTY TO EPA's e-MANIFEST SYS T-AA <br />