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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 4.Manifest Tracking Number WASTE MANIFEST p 1 800-535-5053-INFOTRAC 6 3 O O 6 U 4 3 J WAS 5.Generators Name and Mailing Address c*ie4cp Generator's Site Address(if different than mailing address) �j(�3�aloZ-53�S �11oF.F� / Generators Phone: �� T 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 91b.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 Wl.Nol. I. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 O z 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER n DM P 352 ul CD FILTER MEDIA) 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED U DM P 352 METAL OIL FILTERS) 4. 3 14.Special Handling Instructions and Additional Information 9B1) PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTALAS REGISTRANT: INFOTRAC 800-535-5053 15. GENERATOR'S/OFFEROR'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 gen ator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year :'AA t��lclr�vtll 8 8 �- 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials w F— Transporter 1 Printed/Typed Name Signature Myth Day Year O rL Z Transporter 2Printed/Typed Na a Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z u5 rn 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 1. t 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed ame!\n< /f 0V—u\e�, 1 ` Signature Month Day Ye EPA Form 8700-22(Rev.12-17) Previous editions are b olete. DESIGNXI LD F'ACILII Y'I 0 ETA's e-MANIFEST SYSTEM