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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000432921 1 800-535-5053 020242464JJK <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> PACIFIC AG RENTALS LLC } <br /> 3540 CARPENTER RD V <br /> STOCKTON CA,95215 I T• <br /> Generator's Phone: 831-970-4564 T <br /> 6.Transporter 11 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIROMENTAL CAL000399638 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number W <br /> 8.Designated Facility Name and Site Address U.S,EPA ID Number <br /> AGRITEC INT DBA CLEANTECH ENVIRONMENTAL CAL000330453 <br /> 5820 MARTIN RD <br /> IRWINDALE CA,91706 x <br /> Facility's Phone: 626-812-7200 W <br /> 9a. 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Noi. <br /> 1,NON-RCRA HAZARDOUS WASTE SOLID(ABSORBENT/PAPER FILTER MEDIA) <br /> a <br /> O 2 DM 200 P <br /> Q 352 <br /> LU <br /> 2.NON-RCRA HAZARDOUS WASTE SOLID(OILY SOLID WASTE/USED METAL OIL <br /> FILTERS) 1 DM 150 P <br /> 352 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Line 1:USE GLOVES AND GOGGLES.CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT:INFOTRAC 800-535-5053;Line 2:USE GLOVES <br /> AND GOGGLES.CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT:INFOTRAC 800-535-5053; <br /> 15. GENERATOR'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[hat the contents of this consignment conform to the terms of the attached EPAAcknovdedgment of Consent. <br /> I certify that the waste minimization 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 /> Generators/Offerors Pdnted/ryped Name bignature Month Day Year <br /> CLOYCE C FITCH JR CLOYCE C FITCH JR 02 1 26 1 2019 <br /> -j 16.International Shipments1:1 <br /> F- Import to U.S ❑Export from U.S. Port of entry/exit: <br /> M Transporter signature(far exports only): Date leaving U,S.: <br /> 14 w 17.TransporterAcknowledgmentofReceiptofMaterials <br /> Transporter 1 Printed/ryped Name Signature on Day ear <br /> a JOHN AFLEJE I JOHN AFLEJE I 02 I 26 12019 <br /> Z Transporter 2 Printed/ryped Name Signature Month Day Year <br /> Q <br /> W <br /> r- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity E]Type ❑Residue ❑Partial Rejection ❑full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) US.EPA ID Number <br /> J_ <br /> V <br /> LL FacIlitys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codas for hazardous waste treatment,disposal,and recycling systems) <br /> coo 1. 2. 3. P.H141 H010 <br /> 20.Designated Facility Ownerar Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/ryped Name Signature Month Day Year <br /> GRACIE D SOTO GRACIE D SOTO 02 28 2019 <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />