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Please prim or type. <br /> Form Approved-0M No,2050-0039 <br /> FUNIFIORMZARDOUS 1•Generator ID Number 2,Page1of 3.Emergency Response Ph4.Manifest Tracking Number <br /> NIFE5T �� � 6DO-535-5053-INFOTRAC '�5 nme and Marling Address Generators Site Address(if different Than mailing address] A <br /> SI <br /> i 5l5 h(cle ' b v.r^ <br /> Generators Phone- r�(]� C-"' 1 6 <br /> 6.Tr8nspoger i Company Name U-S.EPAiD Number <br /> CLEANTECH ENVIRONMENTALINC. CAL000399638 <br /> 7,Transporter 2 Company Name <br /> U-S,EPA ID Number <br /> 8.Designated Facility Name and Stle Address <br /> CLEANTECH ENVIRONMENTAL INC. U.S.EPA ID Number <br /> 5820 MARTIN ROAD CALOOD330453 <br /> IRWINDALE,CA 91706 USA <br /> Facliily's Phone: 626-812-7290 <br /> ga. 9b-U.S-DOT Descriptlon(including Proper Shipping Name,Hazard Class,iD Number- 10.Conlainers <br /> HM and Packing Group(if any)) 11-Total 12,Lind t3.Waste Codes <br /> No- Type Quantity WI.Nal. <br /> a <br /> 1- NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 1 <br /> 0 <br /> LUJ <br /> C�� - - - — <br /> w 2• NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER DM P 352 <br /> t7 FILTER MEDIA) <br /> 3- NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTEIUSED DM P 352 j <br /> METAL OIL FILTERS) <br /> 4. <br /> 14•Special Handl n instruolions and Additfonat lnformalion <br /> 981]PR FILE# 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 91513) (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENViRONMENTAL AS REGISTRANT: INFCTRAC 800-535=5053 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare Oat the wnlents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and laheledlplararded,and are in all respects in proper condition far lranspurt according to applicable international and national governmental regulations-if export shipmenl and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached E PA Acknowledgment of Gomm- <br /> I certify that the waste minimization s[alemen!identified in 40 CFR 262-27(a)(if f air a large quan[i[y generator)or tb)Id I am a small quantity vera r)rs e. <br /> Generalorsl4fferors PrnledlT`yped Name Signalure Iyionlh-r Day Year <br /> 1 C L t,It O <br /> ./�- l <br /> � [emationat Shipments a- 1w <br /> zElImport to U.S- L1 Export from 05 Port of entrylex8: <br /> Transporter signature(for exports only); Dale leaving U.S.; <br /> 11fww t7-Transporter ArkncZ?dgmenl of Receipt of Malenals <br /> Transporter 1 PrinledfTyped Na a Signature <br /> a A9onth Day Year <br /> � y '� <br /> U) Transpo erg nledlFyped Name Signature hAonlh bay Year <br /> F <br /> 113.Discrepancy <br /> 18a.Discrepancy indlraiion Space ❑ Quantity ❑ <br /> Type ❑Residue ❑Parlial Rejection ❑Full Rejection <br /> ManifesE Reference Number: <br /> F 18h.Alternate Fadlily[or Generator] U.S.EPA Ib Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> uj 16c,Signature of Allemate Facility(aF Generaior) jM03nth-D-a, Year <br /> a <br /> NP19.Hozardous Waste Report Management Method Codes(i.e.,codes for hazardous Waste trealmenl,disposal,and recycling systems) <br /> C2 3' 4. <br /> nated Facility{honer ar Operator:Gerttfrcalion of receipt of hazardous rnaienals covered by the manliest except as nded in IEem 18aped Name � Signature � lh <br /> ax <br /> EPR Farm 87p0 22(Rev.]2-17) Previous editions iff <br /> alasolete- DESIGNATED FACILITY TO EPA's 8-MANIFEST 5Y5TEArl <br />