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Please print or type. Farm Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST LCZI �{Z(406?( 1 800-535-5053-INFOTRAC 030026087 WAS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) 12o s-f 6 4/ S V/; -,)-r Generator's Phone: S-60 c 1�7"9Lt` co, 1 -a 6.Transporter 1 Company Name U.S.EPA ID Number CLEANTECH ENVIRONMENTAL INC. CAL000399638 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 IRWINDALE, CA 91706 USA Facility's Phone: 626-812-7200 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(ii any)) No. Type Quantity wt./Vol. 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 rz 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 s c7 FILTER MEDIA) 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 ' METAL OIL FILTERS) Z 4. 14.Special Handling Instructions and Additional Information 9131) PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTALAS 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)(if I am a small quantity generator)is true. GeneratorslOffe ors Printed/Typed Name I Signature Month Day Year � �� Zc J 16.Interna nal Shipments j_ I ❑Import to U.S. ❑Export from .S. /Date art of ent exit: Z Transporter signature(for exports only): leaving U.S.: LU 17.Transporter Acknowledgment of Receipt of Materials F- Transporter 1 Printed/Typed Name Signature Month Day Year a .. C: ��l.tt +Z 21 z Transporter 2 Pr edrTyped Name Signatu Month Day Year r- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a z Fn19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. /L/ 3. _ ^1 4. 20.Designated Facility Owner or Operator Certification c rec9. h..rdn11.q matenals covered by the manifest except as noted in Ileum 18a Printeded Na Signature M th Day rear EPA Form 8 00-22(Rev.12-17) Pre ions editions are obsolete. DESIGN AT D FACILITY TO EPA's&MANIFEST SYSTEM