Laserfiche WebLink
x <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS generator ID Number 2.Paget of 3.Emergency Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST 1t� 1 jx1� � ` 1 800-535-5053-INFOTRAC 0 [)024000 WAS <br /> 5.Gepperator's Name and Mailing Address v a� <br /> f 6 g s x 1 s x m- 1'.'„- Generator's Site Address(if different than mailing address) <br /> ;c�sg t rr + y r <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U,S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. �.CAL000368'f36 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U,S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. <br /> 5820 MARTIN ROAD CAL000330453 <br /> IRWINDALE,CA 91706 USA <br /> Facib es Phone: 626-812-7200 <br /> go. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(g any)) No. Type Quantity WuVol. 13.Waste Codes <br /> Of 1. NON-RCRAHAZARDOUS WASTE SOLID (USEDABSORBENT) DM P 352 <br /> aO <br /> K <br /> w <br /> w 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> CD FILTER MEDIA) <br /> x <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 <br /> METAL OIL FILTERS) <br /> 4. <br /> 14.Special Handling Infractions and Additional Information <br /> 961)PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) <br /> CAI TER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 t <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:(hereby declare that the contents of this consignment are fully and accurately described above by the propershipping name, classified,and are assified,packaged, <br /> marked and Iabeied/placarded,and are in all respects in proper condition for transport according to applicable intemationland national governmental regulations.If export shipmentre cl am the Primary <br /> t <br /> Exporter,I certify that the contents of this consignment conforn to the terms of the attached EPAAcknowledgmenl of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a sma8 quantity generator)is We. <br /> Generator'slOfferor's Pdntedrryped Name Signature Month Day Year <br /> 16.International Shipments <br /> F- ❑Impodto U.S. ❑Export from U.S. Pod of entry/exit <br /> ?1 Transporter signature(forexpods only): Date leaving U.S.: <br /> K 17.TranspoderAcknowledgment of Receipt of Materials ) <br /> Tnsporterl Pdntedlryped Name Signature Month Day Year <br /> a <br /> QTransporter 2 Pdntedrlyped Name Signature <br /> K Month Day Year <br /> 18.Discrepancy ' <br /> Its.Discrepancy Indication Space <br /> Quantity ❑Type El Residue ❑Partial Rejection ❑FW Rejection <br /> Manifest Reference Number. <br /> 181b.Mediate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fadlitlxs Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) <br /> r Month Day Year <br /> Q <br /> y19.Hazardous Waste Report Management Method Codes(fe.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated Facility Omer or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />