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4 <br /> Please printCP <br /> Form Approved.OMB No.2050-0039 <br />(� UNIFORM HA7-ARDOUS 1.Generator 0 Number t.Manifest Tracking Number <br /> WASTE 2 Page 1 of 3 Emergency Response Phone (. , <br /> MANIFEST f '� - � ,` �/ r' t/ + 111 <br /> ((�� ' V <br /> 5.Generators Name and Mail' 1 800-535-5053-INFOTRAC V ;�! J � V YY <br /> AS <br /> g Address L <br /> A V e C ZZ f � �.�Generator's Site Address(d different than ma brig address) <br /> Generators Phone' <br /> 6 T anspo ter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000368136 <br /> 7.Transporter 2 Company Name U.S EPAID Number <br /> n <br /> 8 Designated Fac�hry Name and Site Address U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000330453 <br /> 5820 MARTIN ROAD <br /> IRWINDALE. CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, 10.Containers 11.Total 12 Unit 13.Waste Codes <br /> 4 HM and Packing Group(d any)) No. Type Quantity Wt Not <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> O <br /> LU <br /> Z 2 NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER DM P 352 <br /> LLJ <br /> O FILTER MEDIA) <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 <br /> METAL OIL FILTERS) <br /> C <br /> 4 <br /> C14.Special Handling Instructions and Additional InformaWn <br />}j 9B1) PROFILE # 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> 11 (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS)-if /� ,J <br />/+ CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS 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 a7 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 262.27(a)(if I am a large quantity generator)or(b)(if f am a small quantity generator)is We. <br /> Generaloesiofferors Printed/Typed Name Signature Month Day Year <br /> 16.Inlemabon�Shipments Import to U.S. ❑Efrpgt from U.S. <br /> J Port of entrylexit <br /> ❑ <br /> ? Transporter signature(tor exports only): Dale leaving U S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Uj Transporter 1 Pnnted(Typed Name Signature Month Day Year <br /> o J.)h/) /1- \ 'l <br /> a Signature. Month Day Year <br /> r Z Transporter 2 Pnnled/Typed Name <br /> t- <br /> 18 Discrepancy <br /> 18a Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejerl,cn <br /> Manifest Reference Number <br /> U.S.EPAID Number <br /> 18b.Allemate Facility(or Generator) <br /> J_ <br /> U <br /> LL_ Facilitys Phone: Month Day Year <br /> 18c.Signature of Allemate Facihfy(or Generator) <br /> Q <br /> Z <br /> S2 19.Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposal,and recycling systems <br /> U) 2. 3 4. <br />{ w t <br /> 0 <br /> anifest <br /> 20.Designated Facility Owner or Operato Cerbficab'on of receipt of hazardous materials covered by the mS gnat eecept as noted in Item 18a Month Day Year <br /> Pnnted/Typed Name <br /> ( <br /> GENERATOR'S INITIAL COPY <br /> EPA Form 8700-22(Rev.12'17) Previous editions are obsolete. <br /> 1 <br />