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- onmenta� H <br /> ealth Depall' <br /> s, <br /> �asyit Kong'REH- <br /> IL - LSG A eAP UK III Lib J,.SAeph N 11-28-2Va 16:23 Pa 1 Jr� a paldu,R'0 �1c <br /> Corporate OffiC PR6 eH "es <br /> 4E.E.. }fiK <br /> FR2a7 Martin Road Ste, <br /> C/Ea�� r Clef <br /> tech 5 CSOSK BWP-UMO-Cl Puhrco,rrrncirro 61-19-2013 08.0O Fur kA{ <br /> P I 17] <br /> w Selei -Klean Symms,Ina. <br /> 42lonpwtEr Dllw 11V2 <br /> W Nwrtoll,MA 02061 <br /> SALES OFFI CORPORATE 600-666-6f40 <br /> CE: 24 OR EMERGENCY BOO-d6B-1760{SElaly-gaenl <br /> N61161Dt1 <br /> Name REFERENCE NOR <br /> AddrBSS CUSTBMERA L031334love'%frivol Slap-630 AOB03462-1102310611 TAM bople <br /> 15250 NoM Ihvmn Rd <br /> + 1-6I415 <br /> City state zip Lodi CAN142-0000 SRucwillH:2033-3 TDIIYRkIRA- <br /> EPA Io# PHONE 201-333-9392 SRVC DATE:01-10-2023 TIERI <br /> anifest# <br /> BILL TO CUSTOMER# BILL M •r <br /> U5ea pit L0306/7 laws Trevol IIopE R �Use OVed' <br /> Manifest# 10501 HPEnNepyonii Aw lace <br /> d Antifrt THE Whip 73120-0000 -P <br /> PHONE 406-483-8048 JV7 oted a <br /> or PA PURCHASE ORDER! IAXEXIl ;� ` not b <br /> RT# PRODUCT)SERVICES <br /> T0022100 SERVICESi TOTAL <br /> USE'C)OIL NEON RE OTY UNIT PRICE I" CHARGE : 2 <br /> c PRODUCT <br /> 10013SOO USEO 10766 FEE,OIL 1.0 nER1 nERt nERt ^ ,w11ng f1 <br /> ANTI-FREEZE TIER1 <br /> NON-PRE013A1 u or grey <br /> } 1004300/) 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 "fill ' egtr% <br /> LUTI)MOTIVE OIL + � ' <br /> O H=0!War.,. P.ff w.,- — , montta <br /> naasa ANnfRE47f ea n TIERI nER1 11ER1 ]T et the fE <br /> OEu t15Ell OIL CERTIFICATION:Any u uee0 <br /> facility that is lawfuli a g. ArITaM11nPEl }code. <br /> F- that the contents otthis eonsignrr NALOefNleEOR-O-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 iERYICErpgppUCTS - --`-a Ekir,y la III <br /> (a) (if I am a large quanti TIFR1 nr R1 nFR1 w i.l clEax�e Yus ide <br /> non-conforming will be sub ectt to w aebs 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 KUl any Si acCept, <br /> TYPE OR PRINTTIER1 dorenr.0. klEless � �FULL NAME --------------- to clwi LY Custuan s Anil <br /> l hereby certify that I have read aril TOTAL ODE TIER1 � 3Tades w <br /> this form.I hereby certify this,and ----- <br /> segregated and not comingled with UNPAID BALANCE TRIO RECEIPT TIERt - iTti� dd+tlana <br /> sign as agent on the generator waste 1 actufer c <br /> as a written verification that the wasteIf iBh rEr Eom ce,rep.alfilin IhU 014 opeodlic PCB 4SNcan 3 back of <br /> waste is �tiiiaaCtar <br /> Profile Worksheetand also as Ihealint trEUnp heye 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 /> OENERATDRSTATUI )r waste 11 <br /> CES00:VAhlcIE l declare <br /> CleanTech Environmental,ln1 �7 Zp F 2� <br /> 5820 Martin Road CuIIIRerrerDEflfdjtlj&toN-modneruWEaEpppr[Ij'h"iWpa+ Eped. <br /> Irwindale. CA 9170r3 nrLedudrAhelEdndrrhprEpuadtrnhlruuperbbnlaerdnpIme <br /> EPA ID#;CAR000330019 oppkibla r1p11111ro e1 Re Deperholi frwpErppn iP nE nebrid rheope% <br /> rcrurrrd Ift if to dllri<luhkl of PIA 91Ab4loarµ'el in to prinel Senerlfnp <br /> TANKER# h+MEbhlbrlk Gaidf411IIt*""'xAmd GRRrebr Ill[I C11060 CurbrEer <br /> -- - epreeErD+Ysh+e6rrrdw�ArindbbrbrlaldpyRerumEMrendiAnE,IIEathrlh <br /> +n+EM Grrurtl fxrEE EM hrdllenr preridAd upErlNY I CwYnrr a:A,EnY 6A <br /> TVe checked box is the designated r +�AenurlErplEdbYCufYnundPKrIII;T jnrnpErEbdhuw prnluEKA J*n <br /> CleanTech Environmental,Ini +hr+rwnlfuBdnlgpEPrMlrrdwrdurNn BAnEDPNruedlldupeCOEbnrrL <br /> ❑ CleanTech Environmental,lni Ai Air hntEnatrenilGuyeAr job 11Gb <br /> p11R�IrtW dKM,AnA71MIEgMI <br /> ►hW+Arlfr <br /> ❑ Southwest Processors-412C fbxprnenF;HAprmn Erse hnunurnEunlEflwdEY <br /> ilitdis 4WD AfLr*memo sUiltrlef Clx4nXprtYAhElh 150 <br /> L�- T ��r►�I'�YfIEiY1�MA�E�Yf W <br /> IJJ <br />