Laserfiche WebLink
5 <br /> Please print or type. Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator 9 Number :3 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST v 1 800-535-6063-INF Tice 0 2 0 0`)' � 9 JJ K <br /> 5.Generator's Name and Mailing Address ne a lie Ad s(' i rent n li ) <br /> kV <br /> ult •r�,j}tA _ , tJ frJScJti+ <br /> Generator'sPhonat <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLFANTECH ENVIRONMENTAL CAL00039963P <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address CLEANTECiI�EMJIRQIrENTAI U.S.EPA ID Number <br /> aALOW330453 <br /> 5820 MARTIN RD <br /> IRVONDALE,CA 91705 USA <br /> Facility's Phone: 62&812-720110 <br /> ga. 9b.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)) No. Type Quantity Wt.Noi, 3.Waste Codes <br /> 1, NON-RCRA HAZARDOUS WASTE SOL113(ABSO'lPAPER hiLTE -)m io i <br /> p MEDIA) <br /> z 2 NON-RCRA HAZARDOUS WASTE SOLID(OILY SOLID WASTEIUSED DIM, P 352 <br /> LLI <br /> METAL OIL FILTERS) 9 <br /> S -!1A8SOR8F.NT)- ,,q _ 35 <br /> 4. <br /> 14,Special Handling Instru ddl anon f �� 1 <br /> 981pR01=iLE#• _9B2)PROFILE# ' J -SWRROPMEt— USE GLOVES AND GC`C3GLESTANKERN <br /> (PAPER FILTERS) (METAL FILTERS) . -(PAPEA-Fli.-TE <br /> CALLER WS'T IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT; INFOTRAC 800-536-5053 <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of thls consignment are fully and accurately described above by the proper shipping name and are classified,packaged, <br /> marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable lntemational 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[arms of the attached EPAAcknowledgment 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)(ill am a small quantity generator)is true. <br /> Genera slOffercWs Printedrryped Na e r i Signature Month Day Year <br /> 16,International Shipments <br /> i— ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> ? Transporter signature(far experts only): Date leaving U.S.: <br /> W <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> 11-- Transporter 1 PrinlediTyped Name f , Signature Month Day Year <br /> a J / <br /> Transporter 2 PrintediTyped Name` Slgnalur Morih Day Year <br /> 0- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ QuantityType Residue <br /> ❑ yp Partial Rejection Full RejeClion <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> LU 16c.Slgnalure of Alternate Facility(or Generator) Month Day Year <br /> a <br /> x <br /> Fn19.Hazardo , aste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJ 1. � 2. � 13. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as riled in Item 18a <br /> Pr'tntedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Prevlou§editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />