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Please print or type. Farm Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator IO Number 2.Page 1 of 5.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST 020024- 890 JJ K <br /> 5 Generator's Name and Mailing Af4dress- <br /> 1.. ,-� C� r �(.,� 7 efator s S'deddress(if different Thar mailing ad ess) <br /> r A.' 1 _�����- t. 1:��' �.� � �_I T-�+'l 1•Y � �r� <br /> Generator's Phone: �' r �' ._{ X. <br /> 6.Tfansporler 1 Company Name U.S EPA ID Number <br /> CLEANTECH ENVIROMENTAL CAL000399M <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 <br /> 5820 MARTIN RCAL000330463 <br /> ia <br /> IRWVINDALE,CA 91705 IDSA <br /> Facility's Phone: 826-812-7200 <br /> ga 1 96.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10 Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nof <br /> 1' NON-RCRA HAZARDOUS WASTE SOLID(ABSORBENT/PAPER FILTER DM P 352 <br /> o MEDIA) <br /> w <br /> 2. NON-RCRA HAZARDOUS WASTE SOLID(OILY SOLID WASTEAJSED DM P 352 <br /> METAL OIL FILTERS) <br /> 3— {4C�16�R�41iAZAR�ALfS WyAAuCa#i�{ ED-ABaQJIB �4 5 <br /> 4 d�iON �RDGUS-WEE-90W&GWY431681452.- <br /> � r <br /> 14.Special Handling Instructsa sand 3fditi tial Rkribatlon (j <br /> 881 PROF ILE# E`' 9B2)PROFILE#(PAPER FILTERS)FILTERS) (METAL FILTERS) {tl&D-M&ORBl0}-f9WH)ESRkq}-USE GLOVES AND GOGGLES TANKER#. <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 <br /> 15. GENERATOR'&CFFEROR'S CERTIFICATION: t 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 labdedlplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmenlal regulations.If export shipment and I am the Primary <br /> Exporter,}certify that tho contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that rhe waste minimization statement identified in 40 CFR 262.27(a){If I am a larqe quantity generator)oT(b)(if)am a smatl quantity generator)is true. <br /> Generalo'slofferor s Prinledrryped Name / Signature Month pay Year <br /> 16.International Shipments} r <br /> j~ ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> "Transporter signature(for exports only), Date leaving e.- <br /> IX 17 .TranspcknerAcknowledgment of Receipt of Materials <br /> Transporter f Printedryped Name Signature t Month Day Year <br /> O r 1 <br /> Transporter 2 Printed/Typed Name i Signature r Month Day ear <br /> 21 1 <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space <br /> Quantity L-1 Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 186.Akerrale Facility(or Generator) U.S.EPA ID Number <br /> V <br /> Facility's Phonein I, <br /> LLI f Sc.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> r» 19.Hazardous Waste Report Management Method Codes(i.e.codes for hazardous waste treatment;disposal,and recycling systems) <br /> UJ 1 2.t I <br /> 4 <br /> 20.Designated Facility pwner br dperator 'rlification of receipt of ha7aros materials covered by the manifest except asncted in Rpm 18a <br /> PrmtedlTyped Name <br /> l —gnature f f felon Day `(ear <br /> EPA Form 8700.22(Rev.12-17) Previous edit ons are obsolete. y DESIGNATED FACILITY T4 GENERATOR <br />