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Please print or type, <br /> T.Genera! IQ Number Form Approved-01v}g No,2050-0fl39 <br /> UNIFORM HAZAIZ11DUS 2-Page t of 3.Emergency Response Phone 4.hi Rest Tracking Number <br /> WASTE MANIFEST CA--t [ 800-535-5063-1NFOTRAC a p s p s u As <br /> 5.Generator s Name and Mailing Address Generator's Siie Address of different than rr iiing address) <br /> Cd <br /> Generator's Phone,, w , <br /> 6.Transporler 1 Company Name <br /> U.S-EPA Ill Number <br /> CLEANTECH ENVIRONMENTAL INC. CAL000399638 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> &Designa led Facility Name and Site Address <br /> CLEANTECH ENVIRONMENTAL INC. U.S.EPA ID Number <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 USA <br /> Facilily's Phone: 626-812-7260 <br /> ga- 9b.U.S.OOT Descriplion{including Proper Shipping Name,Hazard Class.ID Number, 1f].Can[ainers <br /> HM and Packing Group(if any)) 11-Tolal 12-Unit 11 Wasrte Codes <br /> No, Type quantity WlJ i. <br /> 1 NON-RCRA HAZARDOUS WASTE SOLID [USED ABSORBENT) DIM <br /> 0 P 352 <br /> v <br /> 7• NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENTIPAPER DM <br /> FILTER MEDIA) P 352 <br /> 3- ANON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTEIUSED <br /> METAL OIL FILTERS) DM P 352 j <br /> _ I I <br /> a. <br /> t <br /> I <br /> 14.Special Handlingg lnsf actions and Additional Informativn <br /> 9B1} PIR FILE# 9B2]PROFILE# USE GLOVES AND GOGGLES <br /> {ABSORBENT} {PAPER FILTER} 933} (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRON MENTALAS REGISTRANT: INFOTRAC 800-635=5053 <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the conlenls of this cvnsgnment are fully and accurately described above by the proper shipping name,and are cfassifled,packaged, <br /> marked and tahetedlplacarded,and are in all respects in proper condition for transport according!v appllcahle intamationatand national governmental regulainns.If export shipment and I am the Primary <br /> Exporter,I certify Ilial the conlenls of tlris Coaslgnnrenl conform to the terms of the attached E PA Acknoydedgment of Consent_ <br /> I certify that the waste minimization slalemenl identified in 48 CFR 262.27(a)til t am a large quantity generalor)or(b)(if[am a small quantity erator)is i - <br /> Genenalot'slolferoa•s Priated[Typed Nam Signature <br /> Month Day Year <br /> j 16-International Shipments �� Z <br /> H Import to U.S. ❑Export U.S. Port of entrylexn; <br /> Transporter signature{for exports only); <br /> Dale leaving U.S-: <br /> of 17-Transporter Acknowledgment of Receipt of Malerials <br /> ut <br /> Transporter i PdaledlType Name Signature <br /> a�Z Month Day Year <br /> z Transporter edlTyped Name Signature <br /> 91 Day Year <br /> 18-O screpanoy <br /> 188.Discrepancy Indication Space <br /> ❑ Ouanlily ❑Type ❑Residue ❑Partial Rejaclion ❑Futl Repiclion <br /> 196.Alternate Facility[or Generator) <br /> Manilest Reference Number; <br /> U.S.EPA 0 Number <br /> C.? <br /> d <br /> �+- Facility's Phone: <br /> W 19c-Signa lure of RRemate Facility[or Generator) <br /> a hfonlh Day Year <br /> 19,Hazardous Waste Report Management Method Codes Q.e co es for hazardous wa5le treatment,di Mai,and recycling systems) <br /> Lu C3 T 2. <br /> 20.Qesignated Facility Owner or Operator:Certification of reL,o-1 hazardous mal lots covered by the manifest except as noted in Item 18a <br /> Prinled/Typed Name Signalure <br /> P12 1 - Month Day Year <br /> EPA Farm 8700.22{Rev-17-17) Precious editions a salete, DE: A 1 ED . CII]TY TQ EPA's e-MANIFEST SYSTEM <br />