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Please print or type- Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1 Gene',Mor 10 Number 2.Page 1 of 3.Emergency Response Phone 4,MenifestTracking Number <br /> WASTE MANIFEST 0 .j 7 1 800-535-5053-INFQTRAG 0 3 0 0 2 6 0 2 2 WAS <br /> 5.Generator's Name and Malling Address {� Generator's Site Address(if different than mailing address) <br /> 13SIS /jq <br /> Generalor s Phone: 'P b t,, u <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000399638 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address CLEANTECH ENVIRONMENTAL INC. U.S.EPA ID Number <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> ga 91b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 1D.Containers 11,Total 12.Unil 13.Waste Codes <br /> HM and Packing Group(if any)) No_ Type Cluordrly WI.Not. <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 r <br /> I <br /> 2 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER DM P 352 <br /> C07 FILTER MEDIA) <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTEIUSED DM P 352 <br /> METAL OIL FILTERS) <br /> A.Special Handling Instructions and Addilbrial Information <br /> 981)PR❑FILE# 982}PROFILE# USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 983) (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535=5053 <br /> 15. <br /> GEN ERATOR'SIOFF EROR'S CERTIFICATION: I hereby declare that the conlents of this conslgnmanl are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and tabeladlplacarded,and are in all respects in proper condition for Transport aacnrding to applicable intemationaland national governmental 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 attached EPA Acknowledgment of Consanl. • <br /> f certify that the waste minimizalion statement identified in 40 CFR 262.27(a)(if I am a large quantity generalor)or(b)(if i am a wall quantity ge tor)is Inje. <br /> 171or'slOfferoes Prialleed[Typed Name Sig Lure Month tDay lYear <br /> 2 d <br /> ■ �' Y <br /> 16.Inlemalional Shipments <br /> El Imporl to U.S. ❑Export from U.S. Part of enlrylexil; <br /> ? Transporter signature(far exports only): Date leaving U.S.: <br /> W 17,Transporter Acknowledgmerit of Receipt of Materials <br /> Uj <br /> Tran porter t PrintedlTyped a Signature Month Day Year <br /> a [tea e� <br /> 4 Transporter 2 Nntedrryped Name Signaldr Nlanth pay Year <br /> 18,Discrepancy <br /> 16a.Discrepancy Indication SpareUua ..=y ❑Type ❑Residue ElPartial Rejection ❑Full Rejasbion <br /> Manifest Reference Number. <br /> F 18b.Alternate Farilily(or Generalor) U.S.EPA ID Number <br /> J_ <br /> U <br /> Farility's Phone: <br /> LU 18c.Signature of Allemate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> LO 0 1. 2. �� 3. 4, <br /> 20.Designaled Facilily Owner or operator.Certification of receipt of hazardous materials covered by The manifest except as noted in item the <br /> PdnledRyped flame Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANI FEST 8YSTEM <br />