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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4.Mai " a dent Tracktn Number WASTE MANIFEST ; �` ' 18 6 J J K 5.Generator's Name and Mailing Address- Gerieralor's 5ileAddress(if different than mailing address) Generator's Phone: l 6.Transporter 1 Company Name U.S.EPA 1D Number CLEANTEPM ENIARIONMENTAL CAL0003681.7 7.Transporter 2 Company Name ! U.S.EPA ID Number 8.Designaied Facility Name and SiteAddreshLEANTECiril F-WffRCINIVENTAL U.S.EPA ID Number 5620 11 K0 P-M!i r-4, 91706 USLA 626-612-72W Facility's Phone: 99 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 Wtivoi. w2.tYUr+-INU .f, ,-dAXtf '1 utdASTt�°�tJ1)(Oil—IF`ai�_V i'�'t-.S1L,' �a11 �.,. thETAL.C&FILTLR3) t f` 4. e 14.Special Handling Instructions and Additional Information— 1) 5rr USE Wit_{'",lE.';AND GOOsaLES --- TiiTAL FVERS'f GALLEF,M6''% 0EfdTtic Y CLEAP33'ECH VfARONIIAENTAL AS R EGGT R..AP41r: IINFOTFUAC$00-5315-5503 i 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 labeledlplecarded,and are in all respects in proper condition for transport according to applicable international and nat'.'7'govem'Fti I 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 EPAAcknowledgment 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 a!1 quanti/ggenerator)is true. Generator's10(fe�jo�s��Printed/Typed N e Signature Month Day Year 16.International Shipments ❑Import to U.S. ❑Export from U3. Port of entryfexit: Z Transporter signature(for exports only): Date leaving U.S.: L f7.Transporter Acknowledgment of Receipt of Materials r Transporter 1 Printed/Typed Name rl Signature Month Day Year % QTransporter 2 PrinSedlTyped Name Signature Month Day Year r 18.Discrepancy 1Ba•Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U L<L Facility's Phone: Lo 186.Signature ofAfternate Facility(or Generator) Month Day Year Q X 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. F .. �,:, S 4. L) 20.Designated Facility Owner or Operatg(Certification of receipt of hazardous materials covered by the manifest except as noted in It�xfoa PrintedPfyped Name F.� Signature ! } Month Day Year EPA Form 8700.22(Rev.3.051 Previous editions are obsolete. DESIGNATED-FACILITY TO GENERATOR