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124 E Walnut St, Lodi, CA 95240 PR0517917 <br /> 08/23/2021 Program: HW <br /> PHOTO 7: <br /> Si ned manifest was not on site—CORRECTED ON SITE _ <br /> HAZARDOUS 1 Gererabr ID Number 2,Page 1 Of 3.Emergency Response phone4.Manifest Tnckin V Number <br /> :MANIFEST 1 800-535-5053-INFOTRAC 030615540 WAS <br /> aVAs Nam and Maung Address (3ereraW/B Site Address(N dAerent than ma,h g address) <br /> ART' <br /> G eneretoi s Phone U.S.EPA ID Number V <br /> I Transporter 1 Lomparry Name AliR� <br /> CLEANTECH ENVIRONMENTAL INC. CAL000399638 �LEAVI <br /> 7 Transporter 2 ConiDanY Name U.S.EPA ID Number -SCOY <br /> USEC <br /> B Designated Facility Name and Site Pddmss U.S.EPA ID Number <br /> � CLEANTECH ENVIRONMENTAL INC. CAL000330453 NO. <br /> 5820 MARTIN ROAD <br /> IRWINDALE,CA 91706 USA <br /> Facilrt s Phone 626-812-7200 - <br /> 'd; ga 90.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Patl mg Group(d any)) No. Type Quantity Wt.Nol. .T SA <br /> r t NON-RCRA HAZARDOUS WASTE SOLID (USED ABSORBENT) DM P 352 Np,tO.tAy F1AL� <br /> O <br /> � � _ Aod ue So proper c <br /> i <br /> 2. NON-RCRA HAZARDOUS WASTE SOLID (ABSORBENT/PAPER DM P 352 yoS ornate genesd <br /> FILTER MEDIA) - a Aotuivrizedbna <br /> 04 <br /> CIO. <br /> °fs <br /> �? s <br /> Oa lyf O� 3. NON-RCRA HAZARDOUS WASTE SOLID (OILY SOLID WASTE/USED DM P 352 the Stnte at <br /> 1 O I METAL OIL FILTERS) _- fitted by <br /> o� <br /> j <br /> 4, on nnPASd balances.T1 <br /> • ry I , <br /> crment of U Ss obug-"' <br /> A and 14.Special Handling Instructions and Additional Information <br /> pr 'nPzDpar 9B1)PROFILE# 9B2)PROFILE# USE GLOVES AND GOGGLES <br /> content/ 7 (ABSORBENT) (PAPER FILTER) 9B3) (METAL FILTERS) <br /> '0OTntenlsoy I nsenl <br /> .entafCoCALLER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT:INFOTRAC 800-535=5053 <br /> z7alion,O'S'o ny, <br /> 4e S 15 GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> � Orin the s97alu a marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> bill,as Y the Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> emp'bYae or A I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quanfity generator)or(b)(if I am a small quantity generator)is true. <br /> 4e4edin/tern IS Q GeneratoesrORerofs Printed/Typed Name Signature Month Day Year <br /> xepr �Ybe <br /> ��Bandsr9ning Q 16.International Shipments <br /> ❑Importto U.S. ElExport from U.S. Port of entrylexit: _ <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17,Transporter Acknowledgment of Receipt of Materials N r v <br /> 1' 1 2 I Transporter 1 Printed/Typed Name ' ; \ Signature Month Day Year <br /> r` o <br /> V z Transporter 2 Printed/Typed Name Signature Month Day Yeal <br /> 4' y9 18.Discrepancy <br /> 1 + 183.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Ntemate Facility(or Generator) U.S.EPA ID Number �^_y <br /> ULL ITdel#.Facility's Phone: <br /> w 18c.Signature ofAkemate Facility(or Generator) on Day Year <br /> a 3 . <br /> z <br /> CD19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W <br /> O 1' 2. 3. q, ' <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except az noted in Item 1 Be !� A <br /> Printed/Typed Name Signature Month -D., 1, - <br /> VICKY VANG-LEE, EHS Page 7 of 7 <br />