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Farm Approved.OM8 No,2050.0039 <br /> Please print or type. 2.Page 1 of 3.Emergency Response Phone C Manifest Tracking Number AS <br /> UNIFORM HAZARDOUS 1.Generator lD Numbs <br /> r , 1 1 <br /> WASTEMANiFEST "a 1 800 535-5053 INFOTRAC nil <br /> tea- 1 -2 Generator's Site Address(if different than mailing address) <br /> 5.Generators Name arxf Mailing Address t �LZr�Tuk' <br /> iNal~-r-3r-A <br /> Gen ej ^r <br /> r torsPhone: l i 2 �,� C1 S 2 �. U.S.Ef A!D NumberC1��,�oo� t CI <br /> 6.Transporter i Company Name —6Rt99f?368'f 3�" <br /> CLEANTECH ENVIRONMENTAL INC. U,g.Ep AID Number <br /> 7.Transporter 2 Company Name <br /> U,S.EPA 10 Number <br /> 8.Designated Facility Nam and Site Address CLEANTECH ENVIRONMENTAL INC. CAL000330453 <br /> 5820 MARTIN ROAD <br /> IRWINDALE.CA 91706 USA <br /> Facillys Phone: 626-812-7200 <br /> ga. esa <br /> 9b.U.S.DOT Dfp6on Concluding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> Nn Type Ouantily WLNol. <br /> HM and Packing Group(if anY)i <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 <br /> O <br /> 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORSENTIPAPER DM P 352 <br /> w 0FILTER MEDIA) , (� <br /> 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTEJUSED DM P 352 <br /> METAL OIL FILTERS) �- <br /> 4. <br /> 14.Special Handling Instructions and Additional Infannabon GLOVES AND GOGGLES <br /> 9B1)PROFILE# USE 9B2)PROFILE# 99 (METAL FILTERS) <br /> (ABSORBENT) (PAPER FILTER) <br /> CALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT. INFOTRAC 800-535-5053 <br /> 15, GENERATOR'SlOFFEROR'S CERTIFICATION, I hereby declare that the contents of this consignment are fully and accuralety described above by the proper shipping name,and are dassUd,packaged. <br /> marked and Iabeledlplacarded,and are in all respells in proper condition for transport according to appticable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certfy that the contents of this consignment conform to the terms of the awed EPAAcknowledgment of Consent. <br /> I certify that the waste minirrrization statement identified in 40 CFR 262.27(a)(if f am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> GeneratoeslOffercrs Printedayped Name 5igrrature Month Day Year <br /> b-11cAZZ <br /> 18,lntematioral Shipments Impart to U.S. Pompom$om U.S. Pad of entryfexd <br /> F- : <br /> � Transporter signature(for exports only): Date leaving U.S. <br /> 17.Transporter Acknowledgment of Receipt of Materials - <br /> Tra--------------------- <br /> nspoAer 1 PrintedfTyp d Name SignaEure j Month bay Year <br /> In <br /> r. <br /> i Transporter 2 Prmted(Typed Name Signature Month Day Year <br /> r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity Type ❑Residue ❑Partial Rejeclion ❑Full Rejection <br /> Manifest Reference Number: <br /> I Bb.Al lemate Facility(or Generator) U.S.EPA 10 Number <br /> J_ <br /> ua Facility`s Phone: <br /> LO IBc.Signature ofAltemato Facility(or Generator) Month Day Year <br /> a <br /> a <br /> 79,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste trealmenl,disposal,and recycling systems) <br /> LU 1 2. 3. 4, <br /> 20.Designated Facility Owner W Operalor:Cart(cation of receO of hazardous materials covered by the manilest except as noted in Item 1 Ba <br /> PAntedrryped Name Signature Month Day Year <br /> EPA Form 6700 22(Rev.12-17) PrevinU5 editions are obsolete. GENERATOR'S INITIAL COPY <br />