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Form Approved.OMB No.2050-0039 <br /> 1.Manifest Tracking Number WAS A <br /> Please print or type. 2 Page 1 of 3 Emergency Response Phone 0 ,/ 1} <br /> 7 0 0 /� 3 0 1. Wµ <br /> 1.Generator ID Number g00-535-5053-INFOTRAC <br /> UNIFORM HAZARDOUS 1 <br /> WASTE MANIFEST Generators Site Address(if differet than mailing address) <br /> 5 Generators Name and Mailing Address <br /> U.S.EPA ID Number <br /> Generator's Phone: CAL000368136 <br /> 6.Transporter 1 Company Name <br /> CLEANTECH ENVIRONMENTAL INC. U.S.EPAID Number <br /> 7.Transporter 2 Company Name <br /> U.S EPA ID Number <br /> CAL000330453 <br /> 8,Designated Facility Name and Site Address CLEANTECH ENVIRONMENTAL INC. <br /> 5820 MARTIN ROAD <br /> IRWINDALE.CA 91706 USA <br /> Faolitys Phone 626-812-7200 11.Total 12.Unit 13 Waste Codes <br /> 10.Cona�ners WINoI. <br /> 9,. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, Quantity <br /> HM and Packing Group(d any)) N0 Type p 352 <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) <br /> DM <br /> llyO <br /> z 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER <br /> DM P 352 <br /> LU <br /> FILTER MEDIA) <br /> 3. NON-RCRA HAZARDOUS WA,-, SOLID (OILY SOLID WASTE/USED <br /> DM p 352 <br /> METAL OIL FILTERS) <br /> 4, <br /> 14.Special Handling Instructions and Additional Intornati 9B2)P R O F I L E# USE GLOVES AND GOGGLES <br /> 981) PROFILE# (PAPER FILTER) gB3)�—(METAL FILTERS) <br /> (ABSORBENT) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-505 <br /> ately <br /> ed <br /> ve by <br /> pping name, <br /> are classified, <br /> 15 marked and labeled/placarded,p acarrded aCERTIFICATION: <br /> d are m a respects io properare that the contents condition for ansportlthis cowgriment are according to applicaC evily and temabonalrand national governmental egulations.lif export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform 10 the terms of <br /> the a a large edEPA Acknowledgmentorf Consent. <br /> 11 am a small uanC generator)is We. <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)( Q ty Signature O( Q ty 9 ) Month Day Year <br /> GeneratorslOflerors Pnntearryped Name <br /> 16 International Shipments FlImport to U S. ❑Export from U.S Port of entrylexit- <br /> F <br /> Date leaving U.S. <br /> Z Transporter signature(for exports only): <br /> W 17,Transporter Acknowledgment of Receipt of Materials Signature Month Day Year <br /> Transporter 1 PnnledliyDed Name <br /> O Month Day Year <br /> a Signature <br /> Z <br /> Z Transporter 2 Pnnted/ryped Name <br /> F- <br /> 18.Disaepanuy rrll <br /> 18a.Discrepancy Indication Space L Quantity U Type ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number. <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> J <br /> v <br /> LL Faalitys Phone: Month Day Year <br /> p 18c Signature of Alternate Fac lity(or Gene ator) <br /> W <br /> Q <br /> Z <br /> C2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,an recycling systems) 4 <br /> En 2. <br /> 0 1. <br /> 20. <br /> Owner or Op <br /> Designated Fa lity erator.Certific abon of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Signature Month Da Year <br /> PnntedffyDe Name y <br /> EPAForm e7oo 2z(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />