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Please print or type. GENERATOR UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number C AL 06) 0 -'334-34.5 2. Pr 1 of 3. Emergency Response Phone 800-535-5053-INFOTRAC 4. Manifest Tracking Number 020 00 4 027 JJK Generator's Name and Mailing Address Generators Site Address (if different than mailing address) CLEANTECH ENVIROMENTAL v16 1 W 0 5 S' 2-0 M.L.Ly-;--k vl aCc-tei ----j_y Vj OACkat-( LA - c't,\,-)D 5 1 1 Generator's Phone: I Transporter 1 Company Name CLEANTECH ENVIRONMENTAL INC. U.S. EPA ID Number I CAL000330453 Transporter 2 Company Name U.S. EPA ID Number I Designated Facility Name and Site Address S . . U EPA ID Number 5820 MARTIN ROAD - CAL000330453 CLEANTECH ENVIRONMENTAL IRWINDALE, CA 91706 USA Facility's Phone: I ga. 9b. U.S.c2KVIAWo74kluding Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11, Total 12. Unit HM and Packing Group (if any))13. No. Type Quantity Wt.Nol. Waste Codes NC)N-HCRAHAARUOUS WAS IL LIQUID (UStU OIL) 1 4.7-1- 4---"... G 221 ri Special Handling Instructions and Additional Information 9131)PROFILE# 1000-221-01 USE GLOVES AND GOGGLES TANKER# Z8 (USED OIL) CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 GENERATOR'S/OFFEROR'S CERTIFICATION: thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, aid are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national govemiental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization stateme Lidentified in 40 CFR 262.27(a) (if lam a large quantity generator) or (b) (if I am II quan ' y : eralor) is tme. GeneratarWeffer5rFPTirtel &Typed "... Signature Month Day Year Name 7/ -- /;(__, I 1-*-- zlI /I _, I- F. 16.1nternati Shipments Import to U.S. Export from U.S. e rt o .entry/exit: Transporter signature (for exports only): ate le . ring .S.: TRANSPORTER 17. Transporte,keonvledgmenk6 aterials Transp Pnnted/Typed ame Signature Month Day Year I I/z_ I--z-f I _. Transpo 4 rintediType am Signature / / Month Day Year I I I I DESIGNATED FACILITY. 18. Discrepancy Discrepancy Indication Space Quantity Type Residue Partial Rejection Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I Signature of Alternate Facility (or Generator) Month Day Year I I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. /I ,3 ; 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed/Typed Name ., Signature' Month Day Year ,/- /X'-k/;e4-..7. A ' • 7 I i EPA Form 8700-22 (Rev. 12-17) Previous editions are solete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM