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26 N Cherokee Ln, Lodi, CA 95240 PRO513581 <br /> 12/02/2021 Program: HW <br /> PHOTO 9: <br /> Final si ed cop of manifest was not found on site—CORRECTED (Abid Khan was shown how to retreive copy from DTSC website) <br /> o CleanTech En <br /> IOIFORY 11141 OU! I Gawrm b 1Mter 1 Pape 1 d J Fniwgervy Reaporw Plgry 4. 1 Form Approves.OMB No.2050-0039 <br /> wAsrErANIFEtsr 4� 5820 Martin Road <br /> 5Gwwyye N,m.,W MaYN Addrne �� s orf Air ) JJK Irwindale,Ca 91706 <br /> _ (626)812-7200 <br /> Gwwalya rime <br /> 8 TraepuV t Cgnprry Name <br /> CLEANTECH EWJROIMENTAL U S,EPA ID Number <br /> CFLL0002Y.16Sis BILLING ADDRESS <br /> T Tranpubzcomp.ry Nrre <br /> U.S.EPA to Number Payless Auto Repair <br /> a Diii9W dFadeyN— W54Aadreaa U.S.EPA ID Number 26 N Cherokee Ln#E <br /> 5820 MARTIN RD C <br /> CLEANTEfMROMENTAL Lodi,CA 95240 <br /> ALCrtX�33�°.3 <br /> IRWINDALE,CA 91705 LISA <br /> F i lalgne.02"12.7200 <br /> 9. Ib.U.S DOT D..".(Ind&V Prop.Shp"Name,Haim!Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Pacon Group(dairy)) No. Type It otal 12.1Jm. 13.Waste Cades <br /> 1Vit NO <br /> NON-RCRA HAZARDOUS WASTE SOLID(ABSORSENT(PAPER FILTEF DM P 352 <br /> o MEDIA) <br /> P.O.# TERMS Dl <br /> w 2. NON-RCRA HAZARDOUS WASTE SOLID(OILY SOLID WASTMSEO DM <br /> METAL OIL FILTERS) 352 COD Or. <br /> 3 NODHRCRA HAZARDOUS WASTE SOLID(USED ABSORBENT) (11Y <br /> 352 <br /> 200 USED MOT( <br /> 4 1 STOP FEE <br /> 1 E-Manifest F <br /> 14 Special HandbrpinsWchonaivio—ditionaiurfornsoon <br /> 9SIPROFILEM 0B2)PROFILE* 983)PROFILE4 USE GLOVESAIOGOGGLESWi(ERN <br /> (PAPER FILTERS) (METAL FILTERS) (ABSORBENT FILTERS) <br /> CALL ER MIST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT:INFOTRAC 800.53118083 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by Ne proper shipping name,ab are dassified,packagetl, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations.If export shipment and I am the Pnmsry <br /> Exporter,I cert y that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I ceNy that the waste mimmizalion statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ill am a small quantity generator)Is true. <br /> Generatoes/OAerols Pnnlecirpyped Name SignaNre <br /> Month Day Year <br /> t: <br /> 16,International Shipments <br /> ❑Import to U.S. ❑Expan from U.S. Pon of entry/exit'. <br /> Transporter signature(for exports only): Data leaving U.S.: <br /> w 17.TransporterAck-wledgmenl of Receipt of Matenals <br /> Transporter 1 Pnnled/Typed Name S'naNre <br /> O 0 Month Day Year <br /> =Transporter 2 Pnnted/ryped Name <br /> Signature Month Day Year <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑Quantity ❑7 e <br /> YP El Residue ❑Partial Rejection El Full Rejection <br /> THANK YOU FOR YOW <br /> 18b.Alternate Facility(or Genemtm) Manifest Reference Number <br /> U.S.EPA ID Number A FINANCE CIIAROE OI <br /> U INVOICES- <br /> LL Faalittys Phone <br /> 18C.Signature of Alterrom Faality(or Generator) Month Day Year WE NOW ACCEPTVISA <br /> Q <br /> 2 <br /> h1g,hazardous Waste Report Management Method Codes(i,E,codes for hazardous waste treatment,disposal,and recycling systems) <br /> _ 2. 3. 4. <br /> EPhone#Designated Facility OwnerorOperaloc CeNfication ofmceiplofhazardous materials covered by the manifest exceptas noted in Item 18a <br /> Pnnted/Typed Name Signature Month Day Yem I7_00 <br /> EPA Form 8700-22(Rev.12-17)Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> VICKY VANG-LEE, REHS Page 9 of 9 <br />