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Please print or type. Farm Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2,Page I of 3.Emergency Response Phone 4.Manifest Tracking Number WAS j <br /> WASTE MANIFEST L l�� 1 8017-535-5053-tNFOTRAC D3Q026a24 (VAS <br /> 5.Genera lors Name and Miniling Address S- Inc, Generators Slip Address(if different than mailing address) <br /> Generators Phone: T�"� 0 wV <br /> 8.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CALD00399638 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Fad lily Name and Silo Address U.S.EPA 10 Number <br /> CLEANTECH ENVIRONMENTAL INC. <br /> 5824 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> ga 9b.U,S.DOT Description(inducting Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WI.IVaI- <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> rr <br /> 0 — — <br /> 2 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 { <br /> 0 FILTER MEDIA} <br /> f <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTEIUSED DM P 352 <br /> METAL OIL FILTERS) <br /> 14.Speclal Handling Instruct ons and Additional Infnrmalion <br /> 9131}PROFILE# 9132}PROFILE# USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 983} (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC BOO-535=5053 <br /> 15. GENERATDR'SIOFFEROR'S CERTIFICATION: I hereby declare That the contents of Phis consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects In proper condition for transport according to applicable International and national govemmentaf regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the altached EPAAcknowledgmenl of Consent. <br /> I certify that the waste minim izalion slatement identified in 40 CFR 2B2.27(a)(if I am a large quantity ganeralar)or(b)¢f I am a small quantity pKeralrua. <br /> GaneratnrslDfferors Pdriledityp Na' Signature Month Day Year <br /> _j 16.InlemationalShipman% <br /> im— ❑Import to U. . ❑Export from U4. Port of enttylexit: <br /> K Transporter signature(far exports only): Dale leaving U.S.' <br /> 94 LU <br /> 17.Transporterkkfnowfedgment oReceipt of Maledals <br /> Trans orter 1 Prnledlfyped Name ,,, Signal Month Day Year <br /> D- <br /> 0 Lr7� <br /> Transporter2 tedffyped Name Signature Month Day Year <br /> F <br /> 15.Discrepancy <br /> Iea-Discrepancy indication Space ❑ Quantfly Type Rejection ej <br /> T Residue Partial Re'cGon Full R action <br /> Manifest Reference Number. <br /> 18b.Allermle Facility(or Generalor) U.S,EPA ID Number <br /> a <br /> L7 <br /> Facility's Phone: <br /> [ii 19n.Signature ofAllernale Facility(or Generator) Month fay Year <br /> d <br /> urr] 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous was la treatment,disposal,and recycling systems) <br /> C 1. 2. 3. 4 <br /> 20.Designated Facility Owner or Operalor:Certification of rec6pl of hazardous malerlats covered by the manilest except as rued In Ilem 18a <br /> Printadfiypad Nama � plo Signature Mmttr Day Year <br /> EPA Farm 8700-22(Rev.12.17) Previous editions are obsolete. I]ES GNATED FACILITY TO EPA's a-MANIFEST SYSTEM <br />