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Please print or type. Form Approved. OMB No 2050-403) 4 GENERATOR o. I UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />(/[.. o(f ) 2. r3fg <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />800-535-5053-INFOTRAC <br />4. Manifest Tracking Number <br />WAS <br />Generatoes Name and Mailing Address Generators Site Address (if different than mailing address) <br />A / g_,,7 ./.e. --77fre-e-le-icri 5-7 2 424 ki ign4 / z_ , 0,4, <br />Generator's Phone. gi- 0 I/ e- I <br />Transporter 1 Company Name U.S. CPA ID Number <br />CLEANTECH ENVIRONMENTAL I CAL000330453 <br />Transporter 2 Company Name U.S. EPA ID Number <br />I <br />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 />Facifity's Phone. 626-812-7200 I <br />ga. 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)) No Type Quantity Wt.Nol. 13. Waste Codes <br />1 NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 I <br />NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER <br />FILTER MEDIA) <br />DM P 352 ' <br /> <br />.----I - • <br />NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED <br />METAL OIL FILTERS) <br />DM P 352 <br />I <br /> <br /> <br />(A. I'2..C;1 No 6,17r b..i.A.Air tA.3 / <br /> <br />14,Aki_ NJ Gem ' 1441,c,“Auk t oatk C-i -,5 ' <br />, --- .._ _. <br />1 <br />- <br />1 <br />14.SecialH <br />. <br />andlng Instructions and Additional Information A <br />9131) PROFILE # 9B2)PROFILE# USE GLOVES AND GOGGLES <br />(ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) <br />CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535=5053 <br />1 0 <br />GENERATORS/OFFERORS CERTIFICATION: thereby declare that the contents of this consignment are fully and accurately descrtbed above by the proper shipping name, aid are classified, packaged, <br />marked and la/elect/placarded, and are in all respects in proper condition for transport occluding to applicable international and national governmental regulations. If export shipment and lam the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br />I certify mat the waste minimization statement identified is 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ill am a small quantity generator) is true. <br />Generatoes/Offeroes Printed/Typed Signature Month Day Year <br />../..:2:1_zzc-j _el--, i <br />c"- <br />I d le-c• 1 2:-L; <br />F, International Shipments ImporttO U.S. Export from U.S. Port of entry/exit: E Transporter signature (for exports only): Dale leaving U.S. TRANSPORTER Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 PrintediTyped Name Signature Month Day Year <br />I I I I <br />Transporter 2 Printed/Typed Name Signature Month Day Year <br />I I I I I'-- DESIGNATED FACILITY I 18, Discrepancy <br />Discrepancy Indication Space Quantity Type Residue UPartial Rejection UFull Rejection <br />Manifest Reference Number <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />Signature of Alternate Facility (or Generator) Month Day Year <br />Hazardous Waste Report Management Method Codes (i.e., coda for hazardous waste treatment, disposal, and recycling systems) <br />1. 2. 3. 4. <br />Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in item 18a <br />Printed/Typed Name <br />I <br />Signature Month Day Year <br />I I I <br />EPA Farm 8700-22 (Rev. 12-17) Previous editions are obsolete <br />(IENEPATOITS INITIAL COPY