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SERVICE WORK <br /> C'rg( <br /> C",-)0� ORDER <br /> �PKq 1� jr0a[ I ! 1 2581 S.Sunland Avenue o Fresno, CA 93725 23300 <br /> 1 Phone, 1-830-531-9683 <br /> WWW.Cleantec henv.com <br /> WASTE RECYCLING RECEPT�BULK FLUMS <br /> r <br /> Name '�C�C�f Custcmer Purchase Order# <br /> Address j ! ,— Sales Representative <br /> City State Zipi 1 " i — J Phone# <br /> EPA ID# �/ Cod 2 ! � Ck#1 COD <br /> Manifest#Used Oil v 03ob, r' -_C Manifest#Non Haz Wastewater <br /> Manifest#Used Antifreeze <br /> SHIPPING INFORMATION <br /> p PART# U.S.DOT SHIPPING DESCRIPTION QTY. UOM INT PRICE SUB-TOTAL <br /> tt10022100 USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 221 GAL <br /> W l <br /> W ZE NON-KRA HAZARDOUS <br /> 10013500 USED ANTI-FREEWASTE LIQUID,CA WASTE CODE 135 GAL <br /> 0 <br /> fl0 10043000 NDN-HAZARDOUS WASTEWATER GAL <br /> Man.Fee MANIFEST❑OCUME14T FEE L r— <br /> !– EA. <br /> Y <br /> 0 GENERATOR USED OIL CERTIFICATION <br /> LU m USED Olt.CERTIFICATION:Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling <br /> facility that is lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare <br /> that the contents of this consignment are fully and accurately described above by the proper OOT shipping name and are classified,packaged, <br /> marked, labeled and are in all aspects in proper condition for transport by D,0.1 standards.All relevant information regarding known or <br /> suspect hazards associated with this waste have been disclosed.I certify that the waste minimization statement identified in 40 CFR 26227 <br /> (a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) us t e. Waste materjals which are discovered to be <br /> non-conforming will- subject to additional charges, r <br /> TYPE OR PRINT FULL NAME <br /> GENERATOR SIGNATURE " DATE <br /> I hereby certify that 1 have read and have the au#hority to bind the above fisted generatoCtthe terms found on the frnntand the back of <br /> this form. I hereby certify this,and all attached documents contain true and accurate descriptions of the waste including(hat the waste is <br /> segregated and not comingled with other waste streams.As the Generator, i acknowledge that our site EPA ID#is active.This document <br /> serves as a written verification that the waste stream(s)descriptions and constituents found above are unchanged per the Facility Generator <br /> Waste Profile Worksheet and also as the annual written verification for the generator waste stream profile worksheet of these waste streams. <br /> IrA <br /> re under the penalty of perjury that the foregoing is true and correct. <br /> TRANSPORTER <br /> nTech Environmental, Inc. <br /> S.Sunland Avenue PRINTF LL NAME <br /> �. <br /> Fresno, CA 93725 g , <br /> 1D#;CAL4OQ3Ca81736 A SIGNATURE <br /> R# � -7fL- I ►' I.DATE <br /> RECEIVING FACILITY <br /> 1Z 5 <br /> heckedbox is the designated recycling facility. <br /> anTech Environmental,Inc.-5820 Martin Road, Irwindale,CA 91706 EPA tD#:CAL000330453 <br /> LU LuanTech Environmental,Inc.-4910 Donovan Way,Ste.A, N.Las Vegas,NV 89801 EPA ID#:NVR0o0D9Oo5O <br /> ustial Environmental Services-13350 Grand Valley Parkway, N.Las Vegas, NV 92126 <br />