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j r 111111E WORK ORDER fnvirpnirll�e gal inc, - 2581 S. Suniand Avenue o Fresno, CA 93725 21223 Phone: 1-800-531-9683 www.cleantechenv.com WASTE E EC YCUNG RECEPT-SULK FLUDS Name Customer Purchase Order# Address Sales Representative ,- City State zip J Phone# r_ . EPA ID# CAL Clc#1COD Manifest#Used Oil '7. �C� 7 � Manifest#Non Hao Wastewater Manifest#Used Antifreeze SHIPPING INFORMATION cc PART# U.S.DOT SHIPPING l3ESCRIPTION OTY.JUOM I INT PRICE I SUR-TOTAL 10022100 USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 221 t GAL ccLU W 10013500 USED ANTI-FREEZE NON-RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 135 GAL L7 10043000 NON-HAZARDOUS WASTEWATER GAL Do � Man.Fee MANIFEST DOCUMENT FEE EA. �y qlr 0 GENERATOR USED OIL CERTIFICATION USED OIL CERTIFICATION-Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling facility that is lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare that the contents of this consignment are fully and accurately described above by the proper DOT shipping name and are classified,packaged, marked, labeled and are in all aspects in proper condition for transport by D.O.T.standards. All relevant information regarding known or suspect hazards associated with this waste have been disclosed.I certify that the waste minimization statement identified in 40 CFR 26227 (a) (if I am a large quantity generator) or(b) (it I am a small quantity generator) us true. Waste materials which are discovered to be non-conforming will be subject to additional charges. TYPE Oik NRIINFULL NAME GENERATOR SIGNATURE DATE I hereby certify that I have read and have the authority to bind the above listed generator to the terms found on the front and the back of this form. I hereby certify this, and all attached documents contain true and accurate descriptions of the waste including that the waste is segregated and not ccmingled with other waste streams.As file Generator, I acknowledge that our site EPA ID#is active.This document serves as a written verification that the waste stream(s)descriptions and constituents found above are unchanged per the Facility Generator Waste Profile Worksheet and also as the annual written verification far the generator waste stream profile worksheet of these vlaste streams. I declare under the penalty of perjury that the foregoing is true and correct. TRANSPORTER cc uJ � CleanTech Environmental,Inc. v 2587 S.5unland Avenue PRINT FULL NAME r U) Fresno, CA 93725 X_ W60 < EPA 1D#:CAL000368136 DRIVER'S SIGNATURE F- t r /2' I �1 TANKER#3 b 7 -7 _ _ DATE RECEIVING FACILITY F_ The ecked box is the designated recycling faculty. r'i CleanTech Environmental,Inc.-5820 Martin Road, Irwindale,CA 91706 EPA 1D#:CAL000330453 tu la El CleanTech Environmental,Inc.-4910 Donovan Way,Ste.A,N.Las Vegas,NV 89801 EPA ID#:NVRODO090050 D_ o; ❑ Industial Environmental Services- 0350 Grand Valley parkway, N,Las Vegas, NV 92126