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Please print or type. Form Approved.OMB No.2050-03.9 <br /> UNIFORM HAZARDOUS 1,GeneratorlD Number 2.Page 1 of 7.FJn gertr(Res Phone 4 ManlfestTrack ng Numbe <br /> - - —WASTE MANIFEST Z o©op 5530 1 0 6`l 9 7 --J <br /> , -JA�A�K' <br /> 5.Generaloes Name and Mailing Address <br /> r = orsSifeAddress-ddiiferentthan maili address <br /> , Fop <br /> 3 L450 -fv k "o P IaZq Nay �c�i ItfE qF�J> <br /> Genoralor's Phone: -7—MCV Cok , 95-30 y T9A'S)1CIf§'S <br /> 6.Transporter 1 Company Name <br /> U.S.EPA ID Numbers >. [ <br /> CLEANTECH EI VIROMENTAL INC. , <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> HERITAGE ENVIRON( SERVICES LLC <br /> 284 EAST STOREY ROAD AZD081705402 <br /> COOLIDGE,AZ 85128 USA <br /> Facility's Phone: 520-723-4167 <br /> c <br /> 9a, 9b.U.S.OOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity WLNol. <br /> X 1. RQ,UN1950,WASTE AEROSOLS,FLAMNIABLE,mo.s.,2.1 (PAINT, DM P ; 331 , f <br /> O LUBRICANTS),(D001),ERGs€126 <br /> w 2' <br /> 0 <br /> 3 <br /> ti <br /> A <br /> 3. <br /> F <br /> 4. <br /> 6 <br /> 14.Special Handling instructions n <br /> 9B1)PROFIMt _ USE GLOVES AND GOGGLES TRUCK#_'-7:�2 <br /> (AEROSOLOS) p ' <br /> CALLER MUST IDENTIFY CLE-N4TECH ENVIROMENTAL AS REGI•';TRANT: INFO TRAC 800 53J 5053 <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of Oils consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable inlemalionaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this oonsignmant conform to the terms 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)(ifl am a small quantity generator)is true. <br /> Generator's/ Ser Prinled/T d ame � Signature Month Day Year <br /> / .. <br /> 16.Intemational Shipments I I <br /> i— Impod to U.S. ❑Expo from U.S. Port of entry/exit: <br /> ? Transporter signature(far expods only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLJ <br /> OTransporter 1 Printed7ryped Name ` e Month Day Year <br /> n V. <br /> Cn <br /> c <br /> TransporeB -Pr nleJ(fyped Name coat MonthDay Year <br /> L <br /> 18.Dlscrepa cy <br /> 18a.Discrepancy Indication Space ❑ Quantil <br /> Y ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Genorator) U.S.EPA ID Number <br /> U <br /> FacilitysPhone: <br /> W 18c.Signature of Alternate Facility(or Generator) Monti Day Year <br /> d <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes forhazardous waste treatment,disposal,and recycling systems) <br /> w 1 2 <br /> [] tA `tA( 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Ilam 18a <br /> Pdnled/Typed Name re Idanlh Day Year <br /> s f <br /> EPA Form 700-22(Rev.12-17) Previous editons are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM p <br />