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Please print or type. FormApproved.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 J�� 1 800-535-5053-INFOTRAC 030112474 V�1AS <br /> 4Ge rators Name and Mmling Address si-S � , o r i( Generalor's Site Address(if different than mailing address) <br /> 57031-S3 5lU YCIJT" <br /> Generator's Phone 5I ir— [ _ <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAR000330019 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address CLEANTECH ENVIRONMENTAL INC. U.S.EPA ID Number <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> ga 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt.Nol. <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> H1 <br /> Z 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> O FILTER MEDIA) 00 <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 <br /> METAL OIL FILTERS) <br /> 14.Special Handling Instrudivs and Additional Information <br /> 961)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 EPAAcknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b) ' m a small quantity generator)is true. <br /> E <br /> rv;Printed/Typed Name Signa! , ' i � Month Day Year <br /> J '16.IntemationalShipments <br /> F ❑ImporttoU.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 /> T nsporter 1 Fri edify Name Signature Month Day Year <br /> O <br /> IL <br /> ZI'TrAspoder 2 Ptintadffyped Name re Month Day Year <br /> t- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b,Allemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> C.1 <br /> tai Fa6litys Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. �gA_ <br /> z. � a kw. <br /> 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the mafqest except a noted in Item 18a <br /> 1Printwypame C_rS clot Month Day 'Yeaar <br /> J <br /> EPA Form8700-22(Rev.12-17) Previouseditians t obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />