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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number WAS (� WASTE MANIFEST "ti' �I DU, 1 800-535-5053-INFOTRAC 030066949 VV/1�7 5.Generator's Name and Mailing ddress S?eCc" Generator's Site Address(if different than mailing address) 5i�3-�wZ.53�S ins)S rl� b; Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number CLEANTECH ENVIRONMENTAL INC. CAR000330019 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. 5820 MARTIN ROAD CAL000330453 IRWINDALE,CA 91706 USA Facility's Phone: 626-812-7200 9a. 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(if any)) No. Type Quantity Wt./Vol. 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 a� a w 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 FILTER MEDIA) 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 METAL OIL FILTERS) 4. 14.Special Hardin gg Instructions and Additional Information 981) PRUILE# 9B2)PROFILE# USE GLOVES AND GOGGLES (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 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, 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 EPAAcknowledgment 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 ga rator)is true. Gen IOfferor's Printed/Typed Name Signatur Month Day Year 1101 I l i� 22 16.International Shipments f- Import to U.S./ ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Ce Transporter 1 Printed/Typed Name Signature Month Day Year CL Cl) \', �lzl G e - i (4o Z-- z Tr nsporter 2 Pr' ted/Typed Name r Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: J.- 18b.Alternate Facility(or Generator) U.S.EPA ID Number U Q ' �- Facility's Phone: W 18c.Signature ofAllernate Facility(or Generator) Month Day Year Q z 6, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) p 1• 2. 3. 4. 20.Designated Facility wner or 0 erator:Certification of receipt of hazardous materials covered by the manifest ex pt as not in Item 18a Printed/Typed Name i^' V , l Si ature Month' D Xe EPA Form 8700-22(Rev. -1 ) revious editions are ob olete. UESIGNAI ED FAGILI'I Y 1 U EPA's e NIANIFE51 5YS'I LM