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it <br /> I <br /> I <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> t.Generator ID Number <br />� UNIFORM:;'�4RDOUS G 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST" CQ(Z p p ti t 1 B00 535 5053-INFOTRAC '1 i 1 4 7 WAS <br /> 5 Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Generator's Phone: �� r <br />' 6.Transporter i Company Name U.S.EPA ID Number f- r`C)0�3- -I O 01 <br /> j CLEANTECH ENVIRONMENTAL INC. -Eftt6fl0388'196- <br /> � 7.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. <br /> 5820 MARTIN ROAD <br /> IRWINDALE,CA 91706 USA C A.Ci- 000=��O\C\ <br /> Facility's Phone: 626-812-7200 <br /> 9a. 9b.U S.DOT Description(mduding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(B any)) No. Type Quantity WtNol. <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> 0 <br /> r- <br /> w <br /> z 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> UJ <br /> c7 FILTER MEDIA) / <br /> 3 NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 <br /> METAL OIL FILTERS) <br /> 4 <br /> 14.Special Handling Instructions and Additional Information <br /> 9B1)PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 <br /> 15 GEN ERATOR'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 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 terns of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.270)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generalor's/Ofieror's PrintedrTyped Name Signature Month Day Year <br /> J 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S; Port of entrylexit <br /> ? Transporter signature(for exports only): Date leaving U.S.. <br /> w 17.Transporter Acknovdedgment of Receipt of Materials <br /> I- Transporter 1 PnntedrTyQed Name Signature j Month Day Year <br /> a !— 1'1 y 1 % 12Z <br /> Z Transporter 2 Pnntedrryped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a-Discrepancy Indication Space <br />� ❑ Quantity El Type El Residue ❑Partial Rejection ❑Full Rejection <br /> i <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> C3 <br /> 18c.Signature of Allemale Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 0 19.Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJ 1 F <br /> 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 16a <br /> Printedrryped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />