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Please pant or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS t Generator Id Number 2 Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> a JJK <br /> WASTE MANIFEST t ', `l!'�� f '/ R -"1 "223 <br /> ."` �'2 2 <br /> J i `— $00-535-X053-INFpTf�,C. <br /> 5.Generalor's Name and Mailing Address. , , Gone is Silo drif differ nt than m run adi ss <br /> _td-gt; liLL- ��,_� c=+ r,f 1, U �'� � 9A. � fh�fi C� ,t� <br /> Generators Phone. <br /> 6 Transporler S Company Name U.S.EPA ID Number <br /> CLEV TECH ENVIRONMENTAL C;AI_Gt}0399n35 <br /> 7.Transporter 2 Company Name G S.EPA ID Number <br /> 8.Designated Faciiiiy Name and Site Address CLEANTECH ENVIROMENTAt_ U,S.EPA ID Number <br /> 5820 MARTIN RD CAL00033t'7453 <br /> IRWINDALE,CA 91705 USA <br /> Facility's Phone: 626-812-7200 <br /> ga 9b.U.S.DOT Description(4ncfuding Proper Stripping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit <br /> HM and Packing Group(if any)) W 13.Waste Codes <br /> , t./Vol, <br /> NoType Quantity <br /> 1 NON-RCRAHAZARDOU WASTE-SOLID(A6,50RB NTlPAPER FILTER OM P 352 <br /> o MEDIA) <br /> z 2. NON-RCRA HAZARDOUS WASTE SOLID(OILY SOLID LIVASTEJUSED DM F 352 <br /> LU <br /> METAL OIL FILTERS) 1 05 <br /> �. <br /> �- <br /> 14,Special Handling Mstru I f rmation <br /> 881 PROFILE# rt'J =982)PRf3FiLE#��fid 3;ROF�L,Ea't-- USE GLOVES AND GOGGLES TANKER# <br /> (PAPER FILTERS) (ME=TAL FILTERS) —(PA-PEftfILT€R5)-- <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 <br /> 15. GENERATOR'SIGFFEROR'S CERTIFICATION; I hereby declare that the contents of this consignment are fu;ly and accurately described above by the proper shipping name,and aro classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable inlemational and national governmental regulations.If export shipment aid 1 am the Primary <br /> Exporter,(certify that the contents at this consignment contorm to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identifi d in 40 CFR 282.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true, <br /> Generato'1 ror's PrinledlTyped Name ! Signature hlordl Day Year <br /> �-�� Y J'"7 1 <br /> 16.International Shipments <br /> El import to U.S. ❑Export from U.S. Port of entrylexit: <br /> ? Transporter signature(for exports only( Dale leaving US-, <br /> 17 Transporter Acknowledgment of Receipt of MateriasLU <br /> 1 /� <br /> X _Transporter 1_ ...-. _ ame Signature f y + ] Month Day Year <br /> O <" _ i. <br /> -._. A` .,� . <br /> Transporter 2 Prinled[Typed Name c_. . . Signature / `=.� Mont Day Year <br /> 9 <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space Guano ❑ ❑Partial Rejection <br /> Quantity Type Residue EJ Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA LD Number <br /> U <br /> t¢i Facifity's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day <br /> z <br /> F, 19.Hazardous Wasle Repoq nagement Method Codes(i e..codes for Hazardous waste treatment,disposal,and recycling systems) <br /> LL, 1 <br /> 20.Designated Facility Owner or Operator,Certification of receipt of havirdous mateda)s covered by the manifest except as noted in Item 1 Be <br /> Prinledrryped Name �' <br /> / Signature 1 <br /> i Month" Day) Year <br /> j <br /> `1 ! �t <br /> EPA Form 8700-22(Rev.12.17) Previous editions are obsolete. DENATED FACILI;1f Tp GENERATOR <br />