Laserfiche WebLink
Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page l of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST `I arx'Y%1 4,r*,t 1 800-535-5053-INFOTRAC ()"&0GGQ5 WAS <br /> 5.Generators Name and Mailing Address 1 s Generators SiteAddress(a different than maiMg address) <br /> Generators Phone: zt <br /> 6.Transporter i Company Name U.S.EPAID Number <br /> CLEANTECH ENVIRONMENTAL INC. CAR000330019 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address US,EPAID Number <br /> CLEANTECH ENVIRONMENTAL INC. <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 USA <br /> Facility's Phone: 626-812-7200 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> 0 <br /> 9 <br /> z 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> FILTER MEDIA) i, fit d <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 <br /> METAL OIL FILTERS) <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br />` 9B1)PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> - marked and labeledlplamrded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the tens of the attached EPAAcknowledgment of Consent. <br /> I cerlify that the waste minimization statement identified in 40 CFR 262.27(a)(d I son a large quantity generator)or(b)(if I am a small quantity generator)is he. <br /> t GenefatoesrOfferors Printedlryped Name Signature Month Day Year <br /> 16.International Shipments' A 11 e K r l <br /> ❑Impadto U.S. ❑Expcwth..U.S. Pod ofentrylexit <br /> ? <br /> Transporter signature(for exports only): Date leaving U.S,: <br /> W 17.TmnsporterAcknoWedgment of Remiplof Materials <br /> Transporter l PdntedrFyped Name Signature "-'"'^ Month Day Year <br /> f/J - e i'4. a yjrL .0 lyF-uF., y,ii J/' ' <br /> Q Transporter 2 Prated/Typed Name{ Signature'-" Month Day - Year <br /> H <br /> } 18.Discrepancy <br /> Ise.Discrepancy Indication SpaceI ❑Full Rejeclian <br /> Quantity ❑Type El Residue ❑Padial Re'ec6on <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fadlftys Phone: <br /> w 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1 2. 3. 4. <br /> Y3 <br /> 20.Designated Facility OWoEu MOpend0r.Codification orreceipt of hazardous materials covered by the manifestexcept as road in Item 18a <br /> Panted(typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-1T) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> �4 <br />