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Please print or type.(f=orm designed for use on elite(12-pitch)typeWriler.) Form Approved.OMB No.2050-003:1 <br /> UNIFBRM HAZARDOUS 1.GeoamterlD Number 2.Page 1 of 3.Emergency Response Phone 4.ManNest Tracking Number <br /> WASTE MANIFEST l�J-�, C)oo��1 v'1�7 e u? : rGx_re 018531792 JJK <br /> 5.Generators Name and Mailing Address' C? Generetors SltdAdd(ess d difem I en ailing address) i V')1NA'l <br /> -1. C �p�o� �_ L-vim V, A, 1'�nta. RQ,`"a"AAc��n (01 W> <br /> ?'(A� 1o � li��s k.� 1G1- r �C� \1r1� iv�E C4 <br /> h ki-fv' 21--:2 -04 /CC�LA 0v ll�bo <br /> GenereWrs Phone: <br /> e.Trensporter 1 Company Name U.S.EPA 10 Number I <br /> CLEANTECH ENVIRONEMENTAL __ - CAL0003E31a'6 <br /> 7,Transporter 2Company Name W.S.EPA ID Number <br /> S.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLEAh.TEGH E(NYIRONMENTr'L GAL7•:J'J330A53 <br /> 5620 MARTIN RD <br /> IRWINDALE.CA 81706 USA ENVIRONNIEfvTAL <br /> Feclily's Phone; <br /> 62 812-72W TAaf�. <br /> ga 9b.U.S.DOT Description(Including Proper Shipping Name,Haxand Class,ID Number, IT `X10, ontalners 11.Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(ifany)) Ni Type <br /> Quantity WLNoI. <br /> 1. I1,10I4-RCWk HAZARDOUS WASTE SOLID(.AfSCORBENTIPAPER FII.TEF DPrf P s52 <br /> OF MEDIA) L 1100 <br /> Lu 2• NON-RCRA HA7ARDOUS WASTE SOLJD(OILY SOLID WASTENSED DM LI P a52 <br /> O METAL OIL FILTERS) <br /> 3. rdON-RCFA HAZARDOUS;WASTE SOLID(USED ABSORBENT) DM P 352 <br /> cal 1`�C7 <br /> 14.Special Handling Instruct)6�s� di o al rarmatioh <br /> BBi)PROFILE#�+'U�L902)PROFILEirf O` a)PROFILE'# USEGI-OVES.MIG.GOGGLES7AP4PCER5t,;34� <br /> (PAPER FILTER) (METAL FILTERS) (USED ABSORBENT) <br /> CALLER MUST IDENTIFY CLEANTECH EiVIRONMENTAL AS REGISTRANT: INFOTRAC 300-535-5053 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this cunslgnment are fully and accurately described above by the proper shipping name,and are classlfed;packaged, <br /> marked and Iabeledlplacarded,and are In all respects in proper condition for transport according W applicable International and national governmental regulations.If export shipment and I em the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment W Consent. <br /> I certify that Die waste nimmieatlon 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 /> GenarmorslOfemrs Printecirryp d ams SlgnaWre Month Day Year <br /> I ct—1 w� �_ $ 1l Jr v �' C? ate, <br /> F <br /> r 16.Inlemaaon'al Shipments <br /> ❑import to U.S. ❑Export fm U.S. Pad of entry/exit <br /> ? Transporter signaWre(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> w SlggaWre Month Day Year <br /> Transporter 1 Pdnled/ryped Name r / r ._ <br /> ti <br /> 3 Tanspoder 2 Pdnteonyped Name Monts Day Year <br /> a !h <br /> H <br /> 1B.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Qusnuty L1 Type L1 Residue ❑Partal Rejection ❑FUvRejecuon <br /> Manifest Reference Number. <br /> i8b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> W l8c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.HauNaus Waste Report Management Method Codes(i.e.,caries far heuNaus waste treatment,disposal,and recycling systems) <br /> W01 ��� 2 � ^�� 3. 4. <br /> 20.Designated Facility Owner or Opera c Certification of receipt of Nous malenals cdVered by the manifest as noted in Ilam tea <br /> Pdnted/Typed Name r� SignaWra ` Month Day y/a r <br /> DESIGNATED FACILITY TO GENERATOR <br /> EPA Form 8700-22(Rev.3.05) Previousedifonsamobsolete. <br />