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Please print or type. Form Approved.OMB No.2050- 39 UNIFORM HAZARDOUS 1 Generator 10(lumber 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST �� 1 800-535-5053-I N FOTRAC WAS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Generator`s Phone: B.Transporter 1 Company Name U.S.EPA ID Number CLEANTECH ENVIRONMENTAL CAL000330453 7,Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number CLEANTECH ENVIRONMENTAL INC. CAL000330453 5820 MARTIN ROAD J IRWINDALE,CA 91706 USA Facility's Phone: 626-812-7200 9a. 9b.U.S.DOT Descripflon(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No, Type Quantity Wt.Nol. 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 W 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 O FILTER MEDIA) — 1. 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 METAL OIL FILTERS) t 4. 4 14,Special Handling Instructions and Additional Information 9B1)PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES (ABSORBENT) (PAPER FILTER) 9133) (METAL FILTERS) CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535=5053 15, GENERATOR'51OFFEROR'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,package , marked and labeled/placarded,and are In all respects in proper condition for transport according to applicable fnternaticnal 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)(if I am a small quantity generator)is true. Generator'9101feror's PrintedlTyped Name Signature Month Day iYoar 16.International Shipments ❑Import to U.S. ❑Export tram U.S. Port of enlrylexit. _ Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedfTyped Name Signature Month Day Year O a aza Transporter 2 PrintedlTyped Name Signature Month Day Year oC 18.Discrepancy I 18a,Discrepancy Indication Space ❑ Quantity ❑TypeElI�I Residua ❑Partial Rejection LJ Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J Facility's Phone: w 180.Signature of Altemate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) c 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL OOPY