COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS I.'-Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trac kin Number WASTE MANIFEST t` y' ��7 019 4 319 4 JJ K 5.Generator's Name and Mailing Addr '�`��71 1 1a� Address(if different than mailing address) Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Num r + !� CLEANTECH ENVIRONMENTAL INC Si1I=868eG81 J 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number CLEANTECH ENVIRONMENTAL INC 5820 MARTIAL ROAD CAL000330453 IRWIND.ALE,CA 91706 USA Facility's Phone: 626-812-7200 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. txP - 451 O w 2 NON-RCRr,HAZARQOUS'dVASTE SOLID(OILY SOLID bkASTENSEQ QM P 352 METAL OIL FILTERS) V5 4. 14.Special Handling Instructions and Additional Information 928)PROFI USE GLOVES AND GOGGLES TANKER i cf �`-"v �,ErorT9149)ec�- (METAL FILTERS) CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generar- roi's PdteMd!Na� Signature Month Day �7eear r, A j 1p 16.Inlemational Shi ments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: w17.Transporter Acknowledgment of Receipt pf Materials Transporter 1 Printed/Typed N meS7!— ign re Mootnth Day Year O �7 l 4 Q a z Transporter 2 Printed/Typed a Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ puantiEl ty Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q1 1 Z 05 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) UJI 1. 2. �� 3. 4. 20.Designated Facility Owner or Operator.Certification of eceipt of hazardous material covered by the manifest except as ncteyik Item 18a PrintedlTyped Name Signature , J onth Da ye r EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. IGNATED FACILITY TO EPA's e-MANIFEST SYSTEM