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Signature <br />Mont Day Year <br />1 <br />Transporter 1 Printed/Typed Name <br />Transporter 2 Printed/Typed Name <br />18. Discrepancy <br />Signature Montn Day Year <br />1 <br />•••••••••••••••••• <br />Please pnnt or type <br />I . venerator iu Number <br />2. Page 1 of 3. Emergency Response Phone 4. Manifest TrackMg Number <br />Form Approved. OMB No. 205C-0039 urtirtittm HAZARDOUS <br />5. <br /> <br />Generator's <br />WASTE MANIFEST CiNi La;10.230-7-)B 3 800-535-5053-INFOTRAC I = <br />tx,p n'f)9 WAS Generas Name and ?Mirin Address <br /> Generator's Site Address (if different an mailing address) <br />7 Transporter 2 Company Name <br />CLEANTECH ENVIRONMENTAL U.S. EPA ID Number <br />CAL000330453 <br /> <br />U.S EPA ID Number <br /> <br />amilL- lee up k-ka.) LA. 17- L-ocl c, . Generators Phone. <br />6. Transporter I Compary Name <br />ga. <br />HM <br />8. Designated Facility Name aid Site Address <br />CLEANTECH ENVIRONMENTAL INC <br />5820 MARTIN ROAD <br />IRWINDALE, CA 91706 USA <br />Facirity's Phone: 626-812-7200 <br />Sib. U.S. DOT Description (including Proper Shipping Name. Hazard Class. ID NuTtber. <br />and Packing Group (if any)) <br />1 <br />NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) 2 b...4.t.A4424 otiOrak ca <br />2 <br />NON-RCP HAZARDOUS WASTE SOLID (ABSORBENT/PAPER <br />FILTER MEDIA) <br />3. <br />NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED <br />METAL OIL FILTERS) <br />4 <br />US.EPA iD Number <br />CAL000330453 <br />1 <br />No. <br />0. Containers <br />Type <br />11. Total <br />Quantity <br />12. Unit <br />Wt/Voi. 13 Waste Codes <br />DM <br />750 352 <br />DM <br />DM <br />352 <br />352 <br /> 1 <br />1 <br />2D0 <br />Special Hand'ing Instructions and Aaditional Information <br />981) PROFILE # 982)PROFILE# USE GLOVES AND GOGGLES (ABSORBENT) (PAPER FILTER) 983) (METAL FILTERS) CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT INFOTRAC 800-535=5053 <br />15. <br />GENERATOROFFEROR'S CERTIFICATION: I hereby declare that tie contents of Es consignment are fully and accurately described above by the proper shipping name. arid are cassited, 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 Printery <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 Identified in 40 CFR 262.27(a) (if ! am a large rn.antity generator) or (b) 1 arn a small quantity generator) is true. <br />Generatcr's/Offeror's Printed/Typed Name Signature <br />Month Day Year <br />1 <br />17. Transporter Acknowledgment of Receipt of materiels <br />16 Internabonai Shipments <br />Import to L.S. <br />Transporter signature ((or exports only); Export from U.S Port of entry/exit <br />Date leaving U.S.: <br />Type <br />18a Discrepancy Indication Space Li Clontity <br />lab. Alternate Facility (or Generator) <br />E Residue <br />Manifest Reference Nurnner <br />Li Pate, Rejection Li Full Rejection <br />U.S EPA .0 Number <br />Fadlitys Phone: <br />18c. Signature of Aiternate Facility (or Generator; <br /> <br />I Mont Day Year <br />I 1 <br /> <br />13 20. Designated Facility Owner or Operator. Ce tfica on of receipt of hazardous materials covered by the manifest except as noted <br />in lterr I8a Printed/Typed Name <br />Month Day Year <br />EPA Form 8700-22 (Rev. 12.17) Previous editions ara <br />GENERATOR'S INITIAL COPY <br />19 Hazardous Waste Report Management Method Codes (i.e.. codes for hazardous waste treatmert. cisposal, and recycling systems) 1 12 <br />4 <br />Signature