Laserfiche WebLink
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 <br /> WASTE MANIFEST Cf 1 800-535-5053-INFOTRAC 0 3 0 0 2 6 2 3 2 WAS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> -&W�Pb S- <br /> &W <br /> -.S , W r 0�,b�s <br /> Generator's Phone: U_ C`, 7 1 7(}y <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 Facility Name and Site Address U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 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 Wl.Nol. <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> ., <br /> LU <br /> w 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 ' <br /> 0 FILTER MEDIA) <br /> Sf1f x <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 <br /> METAL OIL FILTERS) <br /> �4------- <br /> 4. <br /> t <br /> 14.Special Handling Instructions and Additional Information <br /> 9B1) PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTALAS 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 /> 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 of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identifed in 40 CFR 262.27(a)(if I am a large quantity generator)or(h)(if I am a small nianfity generator)is true. <br /> Generator'IO eror's Printed/Typed Name Signature Month Day Year <br /> 16.International Mipments <br /> j.._ ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> w <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Oran er 1 Printed Typed Name ^ Signature Month Day Year <br /> Cn <br /> Z Transporter ied/Typed Name Signature I Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Facility's Phone: <br /> F18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> Cn 19.Hazardous ste Report M nagement Method Codes(i.e,,yodes for hazardops waste treatment,disposal,and recycling systems) <br /> LU <br /> L (—d3. � � 4. <br /> t <br /> 20.Designated acility Owner or Operator:Certification of re eipt of ha ardous m terials covered by the manifest excep noted in Item 18a <br /> PrinteJf <br /> d ped�� "' ' Signet Monthr& t�,w— <br /> fi� <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED F ILITY TO EPA's e-MANIFEST SYSTEM <br />