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== C1eanTech == - SERVICE WORK <br /> ORDER <br /> En viro a m e n to l inc. <br /> � <br /> ��7 ILS l 2581 S. Sunland Avenues Fresno, CA 93725 23325 <br /> Phone. 1-800-531-9683 <br /> vvvvw.cleantochenv.corn <br /> TASTE RECYCLING RECEIPT-BULK FLUIDS <br /> Name ���Z� c a Customer Purchase Order# <br /> Address i.5,5 p&rF- p:n, Sales Representative <br /> City State Zip (Z, p c,,,, CA `3 ' 3 f Phone# <br /> EPA ID#C-1r�0 'V33 c`'7] Ck W/COL] <br /> Manifest#Used Oil 5 00{ 3 y oe,rte/' Manifest#Non Hao Wastewater <br /> Manifest#Used Antifreeze <br /> SHIPPING INFORMATION <br /> cc PART# U.S.CLOT SHIPPING DESCRIPTION OTY. UOM INT PRICE SUB-TOTAL <br /> 10022100 USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 221 GAL 0C <br /> W <br /> W 10013500 USED ANTI-FREEZE NON-RCFIA HAZARDOUS WASTE LIQUID,CA WASTE CODE 135 GA! <br /> C'3 <br /> >} 10043000 NON-HAZARDOUS WASTEWATER GAL <br /> LU Marr.Fee MANIFEST DOCUMENT FEE EA <br /> I✓ �•� <br /> W <br /> D. 7 <br /> M <br /> O GENERATOR USED OIL CERTIFICATION <br /> 0 <br /> m USED 01!CERTIFICATION:Any used oil that the transporter receives from the generator will be transported to a certilied used all recycling <br /> ro facility that is lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare <br /> 12 that the contents of this consignment are fully and accurately described above by the proper DOT shipping name and are classified,packaged, <br /> marked, labeled and are in all aspects in proper condition for transport by D.O.T.standards. All relevant information regarding known or <br /> suspect hazards associated with this waste have been disclosed. I certify that tate waste minimization statement identified in 40 CFR 26227 <br /> (a) (it I am a large quantity generator) or (b) (if I am a small quantity generator) us true. Waste materials which are discovered to he <br /> non-conforming will be subject to additional charges. <br /> ' rL� <br /> TYPE OR PRINT FULL NAME NERATOZR SIGNATURE DATE <br /> I hereby certify that I have read and have the authors to bind the above listed generator to the terms found an the front and the back of <br /> this form. I hereby certify this,and all attached documents contain true and accurate descriptions of the waste including that the waste is <br /> segregated and not comingted with other waste streams.As the Generator, 1 acknowledge that our site EPA 10#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 /> I declare under the penalty of perjury that the foregoing is true and correct. <br /> rc <br /> TRANSPORTER <br /> LU <br /> [-�4� L3' <br /> 12: r#. GAL000368136 <br /> Environmental,Inc. �� <br /> Su <br /> Avenue PRINT FULL NAME <br /> Z 25 <br /> 00368136 DRIVER'S SIGNATURE <br /> DATE <br /> r� } RECEIVING FACILITY <br /> LLI <br /> j � The ecked box is the designated recycling Facility. <br /> 52 Fl CleanTech Environmental,Inc.-5820 Martin Road, Irwindale, CA 91706 EPA ID#:CAL00033fl453 <br /> X <br /> w LL 0 CleanTech Environmental,Inc.-4910 Donovan Way,Ste.A, N.Las Vegas,NV 89801 EPA ID#:NVR000090050 <br /> 0 industial Environmental Services-13350 Grand Valley Parkway, N.Las Vegas, NV 92126 <br />