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Please print or type. LA V`--q-2 Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Humber `�, <br /> WASTE MANIFEST +' - 1 800-535-5053-INFOTRAC 030066972 AS <br /> 5.Gsneratoes Name and Malirig7u1rlress �d co Generators Site Address(If different than mailing address) <br /> b(�3 2APL <br /> Generator's Phone: 4)Sljjz <br /> 6.Transporter 1 Company Name U.S.EPA ID dumber <br /> CLEANTECH ENVIRONMENTAL INC. CAR000330019 <br /> T.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000330453 <br /> 5820 MARTIN ROAD <br /> IRWINDALE,CA 91706 USA <br /> Facilitys 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 13.Waste Codes <br /> HIM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> O <br /> z 2 NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> LU <br /> FILTER MEDIA) <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED { DM P 352 <br /> METAL OIL FILTERS) <br /> i <br /> I <br /> 4. <br /> 14.S pecial Handling Instructions and Additional Information <br /> 9B1)PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 9133) (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 <br /> 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, <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 EPA Acknowledgment of Consent. <br /> 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 generator)is true. <br /> eneraloesl0f<erors Printad!Typed Name signalkim Month Day Year <br /> SY u�i�� Cl zz <br /> 16.bttemational Shipments <br /> F ❑Import to U.S. Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> Transporter 1 PrintediTyped Name Signature Month Day Year <br /> z Transporter 2 PrinfedfTyped Name Signature Month Day Year <br /> r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU i. 2. � l 3. 4. <br /> 20.Designated Facility Owner or.Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pr nledffyped Name Signature Manlh Tril!] <br /> G�� trL.t, l Z <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obso! . DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />