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Phase print or hl N— Gereratof 10 Number Farm Approved.OMB No,20r,,0�0,119 <br /> UNIFORM HAZARDOUS 2 Page I of .Frilergency Response Phony 14 11 !11 ilur" <br /> ---F-PN7 T.-fi-3 <br /> WASTE MANIFEST ICA <br /> Ft 51 Generator's Name and Mailim Addis, 4... �fi- 019743201JJK <br /> Gene 0 5 <br /> L— <br /> Re S ss <br /> A0�0 0"on' <br /> �Gonefatot's Ph <br /> one <br /> TransporterIC. <br /> ..any Name <br /> U.S.EPA I D N�um her <br /> CLEANTECH ENVIRONMENTAL,INN ,S <br /> 7.1ranspoil,er2Company Narna <br /> U.S.EPA IL;Number <br /> d Uesignated Facility Name and Site Address <br /> CLEANTECH E-WRONMENTAL INC U.S,EPA I,Number <br /> 5820 MARTIN ROAD CAL000.330453 <br /> IRWINDALE,CA 91706 USA <br /> Facilq's Phone:626,812-7200 <br /> 9a, 13b.U.S.DO I'Dascrit.,.hon(including Proper Shipping Name,Haran;Class,ID Numbor, 10.Containors <br /> HI`A and Par;kjffg GrMP(if any!) — 11.Total 12.Unit <br /> No. Type Quantity tool. 11 Waste Codes <br /> NON-RCRA,HAZARDOUS WASTE SOLID(AOSORBF-- <br /> MEDIA) NTIPAPER FIL.TEN DM P <br /> N< <br /> RAHAZARDOUSWASTE SOLID(OILY SOLID WASTEYUSC-D <br /> METAL OIL FILTERS) 0M P 352 <br /> t4(Dr+Rr,�RA-KVARDOUS,-WASTE-SOIJa�USE-0-ABSORBE — <br /> ON-R <br /> METALC' <br /> 3 <br /> 4, <br /> 14,4,edal aridlingniit—uct"M5 all I'mmon <br /> u <br /> GLOVES AND GOGGLES 4AW40A--7-A� <br /> 981 PROF;LE# ROFILE#, <br /> (PAPER FILTERS) (METAL FILTERS) <br /> CALLER MUST IDENTIF'y CLEANTECH ENVIRONMENTAL AS REGISTRANT:INFOTRAG 800-535-5053 <br /> 15, GENEPATOR'S?'OFFEROR*SCERTIFICATION: I hereby declare that the contents of this cons0­11 are f0Y and acmratelydn'scribed above by the proper <br /> marked a,-YJ Ja5aled!plauarded,and are n all respects in piper condillon for transportaxordirig to applicabl"hishipping name,an'-1 packagod� <br /> mal'Onalar! natio ovegxpori <br /> Expo,jer,I certify that the contents Of this cOmfgnment confirm to the terms of the attached EPAkknowledgmeni of Co L gernmental rulations.itashripriefil and I am ft primary <br /> Icertifythat thowaste minimi7atior)Statement idimfitiod m 40 CPR 262,21(a)(if lam a large quantity generator.)or(b am ap ity generals,)is We. <br /> Generatoes/QfferlorS PrinteV..ped Name We --T"h—5-y year <br /> - <br /> .J 110!7171t4-11r-t&:i�� �� I 1�� P <br /> 16.international Shipments <br /> L"J <br /> import to U.S. EW, Pert Zat enty/exf,Tansprter signature(for only) <br /> Date leaving U.S.: <br /> O� 17.Ttartsp-terAckroMedgmenl of Receipt ofmate� <br /> Uj <br /> Transporter 1 PrintedrTy, Naive <br /> 0 u m1wth Day Year <br /> Transporter 2 Prinled1'ryped Name Signatu <br /> C1 *nth Day yea; <br /> 18a Dscrepancy lndioatbn SpateEl Quantity ❑Type El Rridue ❑Partial Rejection ❑Full Reject,% <br /> 18b Aftemaie Facility(or Generator) <br /> U.S-EPA ID Number <br /> co <br /> FaDhtyg Phone: <br /> I tic.Nglialute 0!Alternate Fatifty(or Generator) <br /> Month Day Year <br /> u1g.Hazardous VYasto Report Ma agement Method Codes(i.o.,ra,des for hazardous tva to Neatment,disarlsal,and rocycfing sys erns) <br /> 7E1.gesignated Facrii l poorer or Qperator. ertiikation of receipt oI hoz rdous materials tuv®rad by the maaitust except as nded in Item <br /> Month Day year <br /> EPA Form 8700-22(Rev,12-17) Previous editions are obsolete, <br /> DESIGN ED FACILITY 0 EPA's e-MANIFEST SYSTEM <br /> I <br />