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I <br /> Please print or type. Form Approved.OMB No.2050-0039 <br />' 1.Generator ID Number <br /> UNIFORMr+��'�AROt)_�U__5 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFESTS c�2 0 q iti l 1 800-535-5053-INFOTRAC 13 S 4 WAS <br />' S.Geaerates Name and Mailing Address L Gereralues Si*Address(if difierenl than mailing address) <br /> Generators Phone: ( r'j ti R <br /> 6.Taansporler i Company Name U.S.EPA ID Number p(Y C)a131�d 0%q <br /> CLEANTECH ENVIRONMENTAL INC. —eAt8003Z'&"6- 1 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> f 8.Designated Faclity Name and Site Address U.S.FPA ID Number <br /> CLEANTECH ENVIRONMENTAL INC. <br /> 5820 MARTIN ROAD <br /> IRWINDALE,CA 91706 USA C AC,Z ©a���j0c) �1 <br /> Facili s Phone: 626-812-7200 <br /> ga. W U-S.DOT Description(mduding Proper Shipping Name,Hazard Class,ID Number, 10.Carlo,ers if.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(f any)) No. Type Quantity WWoI. <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> O <br /> a� <br /> w <br /> w 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 <br /> ra FILTER MEDIA) <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTEIUSED DM P 352 <br /> METAL OIL FILTERS) <br /> 4- <br /> 14.Special Handlin Innuctions and Additional Information <br /> 9B1) PR FILE# 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> (ABSORBENT) (PAPER FILTER) 91213) (METAL FILTERS) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: INFOTRAC 800-535-5053 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:f 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 labeledlplacarded,and are In a➢respects in proper condition for transport according to applicable Internat onal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the Contents of this oonsignmenl conform to the terms of the altached EPA Acknowledgment of Consent <br /> I certify that the Haste nvnimization statement identified in 40 CFR 282.27(a)(if I am a large quantity generator)or(b)[fl am asmafl quantity generator)is true_ <br /> Generato sfUBerars Pdntedrryped Name Signature Month Day Year <br /> ,j 16.International Shipments i <br /> ❑Import to U.S. ❑Export from U'S� Port of entrylexit: <br /> Transporter signature(for exports only): Dale leaving U.S.: <br /> W 17.TransporlerAdmowiedgmentofRemotofMaterials <br /> aTransporter Pnniedff d Name Signalure Meath Day Year <br /> s Transporter Printed yped Name Signature Month Day Year <br /> r <br /> 18.Discrepancy <br /> 1 ea.Discrepancy Indication Space ❑ Quane ty [—]Type ❑Residno Partial Re{euiion ❑Full RnjeeU'on <br /> Man lest Reference Number <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Fadlity's Phone: <br /> w -1—8c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> co <br /> n 1. 2. 3. r <br />` 20.Designated Facility Owner or Operator.Certificaffion of receipt of hazardous materials covered by the manifest except as noted in Ilem 180 <br /> l Prinleclffyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev,12-17) Previous edil;ons are obsolete. GENERATOR'S INITIAL COPY <br />