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- onmenta� H <br /> ealth Depall' <br /> s, <br /> �asyit Kang'REH- <br />{L - LSG A eAP UK III Lib J,.SAeph N 11-28-2Va 16:23 Pa 1Jr� a paldu,R'00 coc <br /> T1s <br /> Corporate OffiC PR6 eH "es <br /> 4E.E.. )RK <br /> FR2a7 Martin Road Ste, <br /> C/Ea�� r Clef <br /> tech 5 CSOSK BWP-UMO-C1 Puhrco,rrrncirro 01-19-202308.00 Fur kA{ <br /> P I 171 <br /> W Selei -Klean Symms,Ina. <br /> 42lonpwtEr Dllw 11 V2 <br /> W Nwrtoll,MA 02061 <br /> `SALE'S OFFI CORPORATE 600-666-6140 <br /> CE: 24 OR EMERGENCY BOC-d6B-1760{SE1aly-Klaenl <br /> 20961610,1 <br /> Name REFERENCE NOR <br /> AddrBSS CUSTOMERA L031334love'%frivol Slap-636 90803462-7202318611 TAM bople <br /> 16260 NoM Ihvmn Rd <br /> + 1-61416 <br /> City state zip Lodi CAN142-0000 SRucwillH:2033-3 TDIIYRkIRF <br /> EPA Io# PHONE 201-333-0392 SRVCDATE:01-10-2023 TIERI <br /> anifest# <br /> BILL TO CUSTOMER# BILL M •r <br /> Usga pit L0306/7 laws TrEvol IIopE R � <br /> UseOVed' <br /> Manifest# 10601 HPEnNEpyonii Aw lace <br /> Used Antifrt THE Whip OM 73120-0000 -P <br /> PHONE 4116-403-8048 JV7 Ojeda <br /> or PA PURCHASE ORDER! TAXE>oIl ;� ` not b <br /> RT# PRODUCT)SERVICES <br /> T0022100 SERVICESi TOTAL <br /> USE'C)OIL NEON RE OTY UNIT PRICE TAA CHARGE : 2 <br /> LLE PRODUCT <br /> 10013500 USEO10266 FEE,OIL 1.0 nER1 nERt nERt ^ ,w11ng f4 <br /> ANTI-FREEZE TIER1 <br /> NON-PRE013A1 u or grey <br /> >- 10043000 NON-HAZARDOUSV 71EH1 <br /> CRANK TIER1 <br /> LU 1ERNICE TERM 2111 <br /> Men.Fee MANIFEST p UOC M fE 66636 USED OIL IW O 71LR1 THEM T1ER1ac <br /> 1I1TL1 <br /> RECYCLE <br /> "fill ' egtr% <br /> LUTI)MOTIVE OIL + � ' <br /> O —'=0!Wer.,. P.ff w.,- - , montta <br /> masa ANnfRE47f ea n TIERI nER1 11ER1 3T et the fE <br /> Oru t15Ell OIL CERTIFICATION:Any u uee0 <br /> facility that is lawfuli a g. AO70M11nPFl }code. <br /> F- that the contents otthis eonsignrr NALOOEWCEOR-0-FEISTIEST:PASS-PPM ti,000 .. be prin <br /> marked, labeled and are in ali a; _ ___ Q, p,Cl'y� - st <br /> --- ilable a1 <br /> suspect hazards associated with} raTAl iERYICErpgppUCT3 - --`-a Ekir,y la IIS <br /> (a) (if I am a large quanti TIFR1 TIER1 nFR1 w i.l clEa@re Yus ide <br /> non-conforming will be sub ectt to w webs F1xv at iix� - q days <br /> cwle,.i. Custalei w" E <br /> y TOTAL CHARDS nER1 kiw s L I Sol 1a lli � ly tPOTf1 <br /> CREDITS � a Wany Si �` ' ;acCept, <br /> TYPE OR PRINTTIER1 dorenr.0. klEless � �FULL NAME --------------- to clavi LY Custuan s Anil <br /> I <br /> hereby certify that f have read ant TOTAL ODE TIER1 � 3Tades w <br /> this form.I hereby certify this,and ----- <br /> segregated and not comingled with UNPAID BALANCE THIO RECEIPT TIERt - 11), �d►tiana <br /> sign as agent on the generator waste 1 actufer c <br /> as a written verification that the wast) 0 p.dahlin Ihrl 014 DNNc PCB 4tificun 3 back of <br /> If hi h r1E0 Eomce,re p waste is �tiiiaaCtar <br /> Profile Worksheetand also as Ihealint trEUnp hlye been colnpleled prlor 10 pumping INS load nTBch to rr �t�ttGatlOn <br /> under the penalty Of perjury that the f( <br /> 1t serves r <br /> OENERAT111113TATU1 )r waste 11 <br /> CES00:VAhlcIE l declare <br /> CleanTech Environmental,ln4 4^] Zp 2� <br /> 5820 Martin Road CuIIIRer4ETDEAIfIEtilj&to"-modneruWEaEppprrlEaYuiWpa+ Eped. <br /> Irwindale. CA 9170x3 nrLedudrrhEbdEndlrrhprEpuadtrnhlruuporbbnEarrdnpIme <br /> EPA ID#;CAR000330019 oppkibla rEpJltEro E1 Rr DeperI oli frwpErppn 11'111104 rhanpA% <br /> 4crurrrd Ift if to dein Irkm of to 91Ab4ubrd rl in to prinr10enerlfnp <br /> TANKER# h+MEb hlbrlk Laid f4j'It*"1ASKWId GRRllbr Ill[I 011060 C urbrEer <br /> -- - 4preeE b JHYtM Ebrrrrlw�Ar Ind b brbrrald py Re rum DldrEndiAnE II Eathrrl <br /> 1n 1 h Grrurtl t1rRE 4M hrd;pnA prrridAd uprlNY M CwYior Ir:b.EnY 61; <br /> TVe checked box is the designated r +�ArnurlrrplEdbYCufYnundPK,rld;T jnrnpErEbdhuw prnluEKA J*n <br /> CleanTech Environmental,Ini +hr+rwnBuBdnlgprPrMlrrdwrdurNn BAnEDPNruldllduptCOEbnrrL <br /> ❑ CleanTechEnvironmental,lni Ai Air hntEnatr,nilGuyeArjob 11Gb <br /> Wlnrnlrtw dir,AnA�ImlrgRl <br /> ►hW+Arlfr <br /> ❑ Southwest Processors-412C fbxprnAnF;HApr4mn IrE hnunurnEunlEflwdEY <br /> ilitdis4WD AfLr*memo sUltr"Clx4nXprtYAhElh 150 <br /> L�- T ��r►�I'�YfEIiY1�MA�E�Yf W <br /> IJJ <br />