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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.General r I Number, `� 2.Page 1 of 3, mergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST ����3 1 800-535-5053-INFOTRAC 030005137 WAS <br /> 5.Generator's Name and Mailing Ad ress .r �e er qhs i A ( �j(( eltkth n mailing address) <br /> btic15—I V11; <br /> f <br /> h`t 1�` <br /> Generator's Phone: ��/1.+1�1KCt1 5 ✓ <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000399638 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address CLEANTECH ENVIRONMENTAL INC. U.S.EPA ID Number <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE, CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Poing-Group(if any)) No. Type Quantity Wt./Val. <br /> /ninny orR ;AZAROG - --DM—'— -`-P '352 € <br /> Q <br /> UJ <br /> UJ 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352LU <br /> ! <br /> FILTER MEDIA) <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 <br /> METAL OIL FILTERS) I ��1 <br /> 4. U <br /> 14.Special Handling Instructions and Additional Information <br /> 'SBTrPRC7t=itE# — 9B2)PROFILE# USE GLOV N O LES <br /> (PAPER FILTER) 9B3 TAL 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 terms of the attached EPA Acknowledgment 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 /> Generator's/Offeror's Printed/Typed me Signature Month Day Year <br /> J 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Part of entrylexiC <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> Y 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Nam Signature Month Da Year <br /> 0 <br /> Cl) cl <br /> Transporter 2 Printed/Typed Name Signature MontT1 Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> g- 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> �a+ Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> M <br /> 2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling sysle ) <br /> 0 1. 2. 3. J4.20.Designated Facility Owner or Operato Certification of receipt of ha rd s materials covered by the manifest except as noted in 1 1 asPrinled(fyped Name `�, QSignature � Mo �Day 'Yp@r <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESI DATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />