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CleanTe h SERVICE WORK <br /> �` ORl3ER <br /> Environmental Inc. <br /> EPA ID#: CAL000368136 08101 <br /> 2581 S. Sunland Avenue• Fresno, CA 93725 <br /> Phone; 1-800-531-9683 <br /> www.cleantechenv.com <br /> Name SCustomer Purchase Order# <br /> Address ,I .�f['� Dv Sales Representative <br /> City State Zip � S� � (� Phone # <br /> EPA ID ) ( � �� Ck#/COD <br /> NDN-RCRAIRCRA WASTE <br /> PART It DESCRIPTION MANIFEST# QTY. UNIT PRICE SUB-TOTAL <br /> 23523155 ABSORBENT MATERIALS (55 GAL.) (f , <br /> J 929000AC AEROSOL CANS (55 GAL.) <br /> CC929000BF BRAKE FLUID (55 GAL.) <br /> 9290006S BRAKE SHAVINGS (30-GAL.) <br /> N <br /> W 8NREGT EMPTY GASTANKS (55 GAL.) <br /> Q 9DO0155 MIXED FUELS(GAS 1 DIESEL) (55 GAL.) <br /> 0 9ORS005 OILY RAGS (55 GAL.) <br /> 0 90SL055 OILY SLUDGE (55 GAL.) <br /> ad 9F00355 PAINTED RELATED MATERIAL-LIQUID (55 GAL.) <br /> F• W 22211055 USED OIL FILTERS-METAL(NOT DRAINED) (55 GAL.) <br /> LLI 23523055 USED OIL FILTERS-PAPER (55 GAL.) 4 /S'TY7j i'.� Q ) <br /> Z 0 22211155 USED OIL FILTERS-CRUSHED (55 GAL.) <br /> MRCRA MANIFEST FEE-RCRA WASTE <br /> LLJ N MNRCRA MANIFEST FEE-NDN-RCRA WASTE 63 C --y (JA I- 4' <br /> Z LUW <br /> 2LL <br /> W F 'Any Non-Conforming Waste Subject to Additional Charges. <br /> < Z EMPTY REPLACEMENT DRUMS <br /> (a J 55OTFF OPEN TDP(55 GAL.)DRUM-REPLACEMENT DRUM FOR USED OIL FILTERS No Charge 0.00 <br /> a 550TWB OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR WASTES <br /> 0 55CTWB CLOSED TOP(55 GAL.)DRUM-REPLACEMENT OF WASTE <br /> Z PARTS WASHER SERVICE <br /> a <br /> J 12BWRS BRAKE WASHER RENTAL UNIT(12-GAL.)PORTABLE AIR OPERATED <br /> Q 30PWRS PARTS WASHER RENTAL UNIT(30-GAL.)DRUM MOUNT <br /> Z SCS- SCS POWERSTAR PARTS WASHER SERVICE-CUSTOMER OWNED MACHINE <br /> 0 PSC- POWERSTAR SOLUTION <br /> Q MANPW PARTS WASHER OIL WATER MANIFEST# <br /> V <br /> LU <br /> a PRODUCTS <br /> N CCGRN55 CLEAN COOL-GREEN 50150 HEAVY DUTY 55 GAL.) <br /> CCGLD55 CLEAN COOL GOLD RECYCLED 50150 EXTENDED LIFE,UNIVERSAL 55 GAL. <br /> UAP100 UNIVERSAL ABSORBENT PADS-(100 PADS PER BUNDLE <br /> UAS030 I UNIVERSAL SOCK-(30 PER PACK) <br /> Customer Print Name_ <br /> Customer Signature: ✓ Date:-(d <br /> Driver 1Serviced By: Date:_ o <br />