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Please pn'ntortype,(Farm designed for use on efite(12-pith)tygewriler.). Form Approved,OMS No:2050-0039 <br /> UNtFORNI HAZARDOUS I-I-neratnr ID Number 12;Pagelorf 3.Emergency Response Phony 14.Maarifes Tracking Number _ <br /> 1NASTE M14NIFEST r , U 1 ,i 5,J J <br /> 5,Generators Name and Wing AddressA,-A G" tisted i re an mailing address) <br /> Generalor�e: � "- <br /> a.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTEC i <br /> 7.Tramporier 2 Company Name U.S.EPA,ID Number <br /> B.Designated Facility Name and Site Address z . z =r n" }r f>^r ;I U.S_EPA ID Number <br /> CLIA.NTECH E-VVIR,[A 'T ,- zI <br /> R?'Vi 'W Lia,'C P, 91709'U SA <br /> Facailtyrs Phore:52E,31 A-T '' <br /> $a_ 9b.U.S.00T Description(including Proper Shipping Name,.Hazard Class,ID Number, 10.Containers11.Total 12.Unit 13.+Neste Codes <br /> HM and TPaddngGroup{d any)). <br /> No, Type Quantity WtNol. <br /> 04 <br /> W 2. CUD fC:li�e.ts_lr���i�?c�?:•�E� u3i � W,��. i <br /> METAL 01:L r-!LTERS� <br /> t <br /> 'U4- <br /> 4, nor;4. <br /> K.Specief Handling Inshelionsand.AddAcM Information <br /> �r <br /> .tir- �S ,$�- r� r tr <br /> +fsa. c c:r y-�rrss WE T?L F3L TER- ;' <br /> CALLER MUST 1DF<jT1'-Y CAN TEC 1 ENl"AFOC<ITe1Eiy<TA,L AS REG::S , T NFO v <br /> i Frua .I Lr-i TF'.;=� - <br /> 15. GENERAT01;VSMFFMR`S CERTIEICAVON i hereby declare that the ocntants of this corsrgnment are fully and accurately described atiave by the proper shipping name,andare class tied,packaged, <br /> marked and labelediplacarded,and'are.in altrespects in properconditionfortmnsport a=rSingtoapplicable'intemationaland national govemmental regulations.If export shipment and I am the Prlmay <br /> Exporter,I ceidfy that the contents or this consignmet tconform to theterms of the aftachedEPAAc&owledgment et Consent. <br /> I cer*thattha wasie mlrrun¢ation statement:idenbTiedtin 40 CFR 262:27(a)(If lam a large quarr2y generator)or(b)(fl am a.small quantity generator)Is true. <br /> Generator'siWarces PnntedfTyped Name Signature Monlh Day Year <br /> Imo'` ✓� _5 r <br /> International nternational Shipmants <br /> 1• ❑Impart to U;S. ❑I3;port from U.S. Port of entrylaxit <br /> Transporter signature(far exports only): Date leaving'U;S.: <br /> il.TransporterA;knoMedgmentof Receipt of MateriaisLl <br /> f. <br /> O :Transported Printedffyped Name 5ignatu { r} Month. Day <br /> y�Year <br /> CL <br /> Trarsporter2 Piintedny ed Karile Signature _ M,orth" Day Year <br /> J= <br /> 18.Discrepancy <br /> 18a.Discmpan y'Indicatieri Space ❑ quantity ❑T e <br /> yp ❑Residue ❑Partial Rejection ❑Full Rejectior <br /> Manifast Reference Number. <br /> 186,Alternate Faciftty(or Genaratoo U.S..EPAID Number <br /> �r <br /> L) <br /> LL Facility`s Phone: <br /> LLI 18c.Signature of Aftemate Facility for Generator) btonth Day Year <br /> 7 <br /> 1 <br /> 19.Hazardous Waste Report Management Method Codes(i,e„codes for hazardous waste treatment disposal,and recyrfirg systems) <br /> o 1, 2. -b 3. 4. <br /> 20.Designated FadliE Owner or Operator:Cef ficatien of receipt of hazardou materWscovered by the manifest except as Wed in)tam 1 Ba <br /> rtedfTyped Name Signature Manlh Da r <br /> ,a t66� f� q <br /> EPA Form 8700=22(Rev.3-05) Previous editions are obsolete. DESIGNATED 1,ACILITYTO DESTINATION STATE ff REQUIRED) <br />