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Fotrn Approved-OMB No.20504039 <br /> 4.Alanifest Tracking Number .■■w S <br /> Please print or type. 2.Page 1 of 3.Emergency Rasponse Ph°ne 030041-301 <br /> ■11RY�x <br /> =UNIFORMARDOU5 1.GeneratorlDNumber 1 800-535-5053-1NFOTRAG F,, IFEST Generators Site Address(d ditlerent than mailing addressf <br /> 5.Generator's Name and UMing Address <br /> U.S.EPA ID Number <br /> Generators Phone: CAL000368136 <br /> S.Transporter 1 Company Name <br /> CLEAN7ECH ENVIRONMENTAL INC. �5.EPAlDNumber <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> GAL000330453 <br /> 8.DesignaWFacitityNam andSite Address CLEANTECH ENVIRONMENTAL INC. <br /> 5820 MARTIN ROAD <br /> IRWINDALE,CA 91706 USA <br /> Fad€i s Phone: 526-812-7200 EN4o. Type <br /> 11,Total 12.Unit 13.Waste Codes <br /> 9b.U.S,DOT Des,-i*n(including Proper 5hi 0119 Name.Hazard Class,ID Number, Ouant ty WtJVbl. <br /> P 352 <br /> 9a. <br /> HM and Packing Group(if any]} DM <br /> t, NON-RCRA HAZARDOUS WASTE SOLID !USED ABSORBENT) <br /> a <br /> D <br /> DM <br /> P 352 <br /> Z 2. NON-RCRA HAZARDOUS WASTE SOLID (AS SORBENTfPAPER F <br /> to <br /> FILTER MEDIA) <br /> 3. DM P <br /> NON-RHA <br /> CRA ZARDOUS WASTE SOLID (OILY SOLID WASTEIUSED <br /> 352 <br /> METAL OIL FILTERS) <br /> d. <br /> 14.Speciai HandfinngglnslructionsandAdditiQrtallnfa-malio9B2 PROFILE# USE GLOVES AND t"aOGGLES <br /> $61}PFiDFILE# }(PAPER FILTEF2} 9B3),��(METAL FILTERS} <br /> (ABSORBENT) <br /> CALLER MUST IDENTIFY CLEANTECH ENVlRDNMENTALAS REG157RANT:INFOTRAC 800-535-50 <br /> 15. GENERATOR'Sft3fFEROR'S GERTIFICATfON: Thereby declare IhaE the cQntenls of Nis eonsignrn�l are fully and aorxrralely described above by the Proper shippkg name,and are classified.packaged. <br /> the Primary <br /> madred and labeledfplacarded,and are in all respects in proper condition for Narrspart acmrdfng to appkcable intematianat and natior�govemmenla!regulations.d exppn shipment and I am <br /> Exporter,I certify N1 the cmlents of this oensgnment oanform 10 the terms of the atlached EPAlACx �0d9r at o1�it s n a small quantity generator)is true- <br /> f certify that the waste minimization statement identified in 40 CFR 262.27(3) rg Quantity eneraure @1 month Day Year <br /> SigrhaGene 210r51offerors Pdnledffyped game <br /> U.S,-.1S.Interna6Qnal 5hiprnerns ❑ le <br /> Date Import to U.S. ❑Export hM U.S Port enl avin9 U.S. <br /> Transporter signature(for evorls onl# <br /> IT.Transporter AakriculedgmentofReceipt o!Materials Signature Month Day Year <br /> Uj <br /> Transporter 1 PrrntedlTyped Name <br /> O Month Day Year <br /> D. Signature <br /> rA Transporter 2 Prfniedlfyped Name <br /> t- <br /> 18_Discrepancy <br /> 180.Discrepancy Indication Space ❑ cwntity ❑Type ❑Residua ❑Partial Reierkon FLA R*cbnn <br /> Manifest Reference Number. <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> w Fadfity's Phone: Month Day Year <br /> 18c Signature QtAltemale Fadlity(or Generalor) <br /> a <br /> 19,Ha7ardaus Wasta Report Management KOOd Codes(i.e.codes for hazardous wasle treatment disposal,and recycling systems) <br /> rn 2. <br /> W 1 <br /> C3 <br /> 20.Designated FadGty Owner or Operator Certification of receipt of hazardous maledals covered by the marafest except as noted in item 18a <br /> Signature Month Day Year <br /> PdntedlfyP�Name y <br /> EPA Form 8700-22(Rev,12-17) Previous editivnsare obsoMe. GENERATOR'S INITIAL COPY <br />