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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS eneralor ID Number 2 Page 1 of 3 Emergency Response Phnne 4.ManffestTracking Number <br /> WASTE MANIFEST 6 20942463 JJK <br /> 5.Generator's Name ani Mailirr&�dress _ General 's Site A tl ess(if differe I than ma'ing address) <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEA14TECH ENVIROMENTAL CAL000389l <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLEANTECH ENVIROMENTAL CALOOD330453 <br /> 5820 MARTIN RD <br /> IRWINDALE,CA 91705 USA <br /> Facility's Phone, 8213-812'7200 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 1G.Containers 11.Total 12.Unit 18,Waste Codes <br /> RM and Packing Group(i1 any)) No. TYi7e Quantity WI.NoI <br /> 1 1- NON-RCRA HAZARDOUS WASTE SOLID(ABSORBENT/PAPER FILTER DM P 352 <br /> W- <br /> 0 MEDIA) <br /> z 2. NON-RCRAHAZARDOUS WASTE SOLID(OILY SOLID WASTEAJSED DIM P 7352 <br /> METAL OIL FILTERS) <br /> Olt. r <br /> 3. idC3N-Ftgfq-I-bkf7f) !S-WArST�-SC3Lf${I�SEfls4$�.y4R - 'I31N! <br /> 4, <br /> 14,Special Handling Instructind dditional Information �r <br /> OBiPROFILE#L' + 8132)PROFILF USE GLOVES AND GOGGLES 7AAFKER# <br /> (PARER ll ERS) (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH EWRONMENTAL AS REGISTRANT: INFOTRAC 8OD-533.5053 <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 labeledlplacorded,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 10 the terms of the attached EPAAcknowledgment of Consent <br /> certify that the waste minimization statement identified in 40 CFR 262.27fa){if I am a tarn oriantlry n?np.-Mor)of m)flfi am F small gvantity g4nera 1s4ma <br /> Genefalor'sfOfferor's Printed ad ame Signature Month Day 'Year <br /> 4 <br /> 16.International Ship n <br /> ❑Import to U.S. ❑Export from U.S. o o enl lexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> aC 11 Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 PrintediTyped Name1 1 . Signature /I1 / f'; 11 Month Day Year <br /> I P. <br /> Z <br /> Transporter2-P-tintedlfyped game Signature /,. Month Day Year <br /> " <br /> 18.Discrepancy <br /> 18a.Discrepancy Indicalion Space ❑ Duantityyp (e <br /> ❑T a El Partial Rejection FuMRe' Ilion <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U,S.EPA ID Number <br /> U <br /> 1 Facility's Phone: <br /> w I& Sigrialireui Ailernote Fadlily(ui Generator) Month Day Year <br /> z <br /> C= 1g Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 7_G.Designated Facility Owner or Oper r.Certi`rcation of receipt of hazardous materials covered by the manifest except as noted in Item 1 l <br /> Printedlfyped Name + Signature i '1 :]Mon;fh tia Year <br /> EPA Farm 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR <br /> ,1 <br />