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Please print or type. Farm Approved.OMB No.2050.0039 <br /> 1. nIM306� <br /> 2.Page 1 of S. -mergency Response Phone 4.Manifest Tracking Number <br /> UNIFORM WASTE M HAZARDOUS <br /> US 1 11 800-535-5053-INFOTRAC .030005137 WAS <br /> 5.Generalor's Name and Mailfng AdMess <br /> r �� � y !� er s i A r�SI)d�l n ding addressS*fa ) <br /> �df r}r�} <br /> T��\\ CA- 5731 <br /> Generator's Phone--: <br /> 6,Transporter 1 Company Name U.S,EPA Ip Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000399638 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated Facility Name and Sire Address US.EPA 0 Number <br /> CLEANTECH ENVIRONMENTAL INC, CAL000330453 <br /> 5620 MARTIN ROAD <br /> IRWINDALE, CA 91706 USA <br /> Facllity's Phone 626-812-7200 <br /> 9, 9b.U.S.DOT Description(including Proper Shippinq Name,Hazard Class,ID Numher, 10.Ccnlainors 1t Total 12.Unli 13 We�la Cads <br /> HM and Packing-GrouP(if any)) No, Type Quantity wt.fvbI' <br /> NIGN R$�fl E-SQL DM— .- <br /> � Ii <br /> 0 ; <br /> 2. NON-RCRA HAZARDC)US WASTE SOLID (ABSORBENTIPAPER DM P 352 <br /> FILTER MEDIAS <br /> 3 NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTElUSt=fl DM P 352 ' I <br /> METAL OIL FILTERS) J�/) ��-__ E,....._.rv.._..i... _. <br /> -F <br /> 4. <br /> i f <br /> 3 <br /> 14.Special Handlln Instructiom andAdditianal Information �"} l� USE GLC?V N LES <br /> -p g=�>W --a---T---- 9132)PRQF'11-E# <br /> (PAPER FILTER) 9B3 TAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTALAS REGISTRANTS INFO-FRAC.B40-535=5053 <br /> 15, GENERATOR'5fOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and actufately described above by the propersidpping name,and are classified,packaged, <br /> marked and laWedfplacarded,and are in all respects rn proper contttuen for transport according to applleable!ntemational and national governmental regulations.If export shipment ane I am the Primary <br /> Exporter,I certify that the contents of this cons!arment conform to the terms of the attached EPAAcknoMedgmart of Consent. <br /> I celffy that tho viaste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity ganeralor)or(5)(If I am a small quantity generator)}s true. <br /> GeneralorVOfteror's PrintedfTyped nature <br /> nxv <br /> Month Day Year <br /> Yi 9K <br /> Import to U.S. ❑Export irorn U.S. Part of enlrylaxit . <br /> Iianspcsler signature{for experts arly1. Dale leaving U.S.: <br /> 17.Transporter Acknaveledgmenl of Receiplof Materials <br /> Transporter 1 PrirdediTyped Nam Signature Month 5 Da Year <br /> r <br /> Z Transpa0z 2 Pfn dfTyped Name Signalure hlnnt May Year <br /> 18 Discrepancy <br /> 18a.Uismvpancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial mecfbn ❑Fulf Rejection <br /> Manifest Reicrence Number: <br /> 18b.ARernale Facility(or Generator) - U.S.EPA M Number <br /> C.) <br /> Facility's Phone: <br /> � <br /> 18c.Signature of Alternate Faclriv(or Generator) Month Day Year <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(_e.,codes for hazardous waste Irealment,disposal,and recycling syste ) <br /> LU <br /> 1. 2 3. 4. <br /> 20.Designaled Facility Owner or Operas CertDlication of receipt of tiydRkx materials covered by the mankestexcept as nolad m 11611;8 <br /> PrintedfTyped Name 519nature jklanlfi Day <br /> EPA Form 8704-22(Rev.12.17) Previous editions are obsolete. DESI IATED FAC)L(TY TO EPA's e-MANIFEST SYSTEM <br />