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Please print or type. Form Approved.OMB No,2050- 39 UNIFORM HAZARDOUS 1•Generator ID(lumber 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Nun WASTE MANIFEST 1 800-535-5053-INFOTRAC Y 5,Generators Name and Mailing Address Generator's Site Address(if different than mailing address) Generator's Phone: 6.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. f'AL000330453 5820 MARTIN ROAD IRWINDALE,CA 91706 USA Facility's Phone: 626-812-7200 9a. 9b.U.S,GOT Description(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 W1.Nol. 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 ILz 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 ' FILTER MEDIA) _ 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTEWSED DM P 1 352 METAL OIL FILTERS) ---- 4. i 14•Special Handling Instructions and Additlonal Information 9131)PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535=5053 15, GENERATOWSIOFFEROR'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 international and national governmental regulations.If export shipment and I am the Primary Exporter,t 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'slOfferor'sPrinledlTyped Name Signature Month Day (Year 16.International Shipments P- ❑Import to U.S. Exportiram U.S. Port of enlrylexit. _ K Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Lij Transporter 1 PrinledlTyped Name Signature Month Day Year O 10- Transporter Transporter 2 PrinledlTyped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejecta Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 16c.Signature of Alternate 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 Facllity Owner or Operator:Certificalion of receipt of hazardous materials covered by the manifest except as rioted in Item 18a Printedl yped Name signature Month Day Year EPA Farm 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL 110PY