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Corporate Office SERVICE WORK <br /> EPA IDS`: CAL000330453 ORDER <br /> C/eanTech 5820 Martin Road • Irwindale, CA 91706 <br /> Phone: 1-800-531-9683 744342 <br /> www.cleantechenv.com <br /> SERVICE WORK ORDER <br /> SALES OFFICE: Q Fresno ❑ Irwindale I] Newark .Sacramento ❑ San Diego <br /> Name �L. { r�c k Customer Purchase Order# <br /> Address , t f r Sales Representative <br /> City State Zip / tr r Phone# <br /> EPA ID # r Ck#/COD <br /> ld.sf` / k <br /> t `4 NONwBCRA/RCirA WASTE rx <br /> PART# DESCRIPTION MANIFEST# QTY. UNIT PRICE SUB-TOTAL <br /> 23523155 ABSORBENT MATERIALS (55 GAL.) <br /> F' <br /> 929000AC AEROSOL CANS (55 GAL.) <br /> Q 929000BF BRAKE FLUID (55 GAL.) <br /> 929000BS BRAKE SHAVINGS (30-GAL.) <br /> Lf) <br /> in 8NREGT EMPTY GASTANKS (55 GAL.) <br /> Q 9DO0155 MIXED FUELS(GAS/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 /> W22211055 USED OIL FILTERS-METAL(NOT DRAINED) (55 GAL.) / zlxGf' fit <br /> W 23523055 USED OIL FILTERS-PAPER (55 GAL.) <br /> Z � 1 <br /> 0 22211155 USED OIL FILTERS-CRUSHED (55 GAL.) <br /> >- r MRCRA MANIFEST FEE-RCRA WASTE <br /> W <br /> LU N MNRCRA MANIFEST FEE-NON-RCRA WASTE O7nnr a Z tt <br /> Z W <br /> LL 'Any Non-Conforming Waste Subject to Additional Charges. <br /> LLIH <br /> EMPTY RE.P,LACEMENT.DHUMS #, <br /> Q55 FF OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR USED OIL FILTERS No Charge Y 0.00 <br /> Q 550TWB OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR WASTES <br /> J <br /> O55CTWB CLOSEDTOP(55 GAL.)DRUM-REPLACEMENT OF WASTE " I i 1 <br /> V 4*1- PARTS WASHER,SERVICE , <br /> ZQ 12SWRS BRAKE WASHER RENTAL UNIT(12-GAL)PORTABLE AIR OPERATED <br /> W 30PWRS PARTS WASHER RENTAL UNIT(30-GAL.)DRUM MOUNT <br /> J SCs- SCS POWERSTAR PARTS WASHER SERVICE-CUSTOMER OWNED MACHINE <br /> U <br /> Z PSC- POWERSTAR SOLUTION <br /> O MANPWPARTS WASHER OIL WATER MANIFEST# <br /> EE <br /> Q xV- PRODUCTS <br /> (� CCGRN55 CLEAN COOL-GREEN 50/50 HEAVY DUTY 55 GAL.) <br /> W CCGLD55 CLEAN COOL GOLD RECYCLED 50/50 EXTENDED LIFE,UNIVERSAL (55 GAL.) <br /> a <br /> UAP100 UNIVERSAL ABSORBENT PADS- 100 PADS PER BUNDLE) <br /> UAS030 UNIVERSAL SOCK- 30 PER PACK) <br /> As the Generator,I acknowledge that our site EPA ID#is active and if needed CleanTech to sign as agent on the Generator Waste Profile Worksheet for this <br /> wastestream(s).This document serves as a written verification that the waste stream (s) descriptions and constituents found above are unchanged per <br /> the Facility Generator Waste Profile Worksheet and also as the annual written verification for the generator waste stream profile worksheet of these waste <br /> streams.I declare under the penalty of perjury that the foregoing is true and correct. <br /> Customer Print Name: ;• <br /> Customer Signature: Date: <br /> D,)vs 9eM d 8y: Date: <br />