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Corporate Office SERVICE WORK <br /> EPA ID#: cAL000��o��� ORDER <br /> CleanTech <br /> 5820 Martin Road - Irwindale, CA 91706 <br /> Environmental Inc Phone: 1-800-531-9683 7 "'0 6 3 3 <br /> vvww.6P7,@ntechenv.corn <br /> SERVICE WORK ORDER <br /> SALES OFFICE: ,21 Fresno ® Irwindale ❑ Newark ❑ Sacramento ❑ San Diego <br /> Name Customer Purchase Order# <br /> Address t f �� I „�; Sales Representative <br /> City State Zip Phone # <br /> EPA ID # Ck#/COD <br /> �• �k NON-RCRA/RCRA WASTE <br /> PART# DESCRIPTION MANIFEST# ®TV. UNIT PRICE SUB-TOTAL <br /> ® 23523155 ABSORBENT MATERIALS (55 GAL.) <br /> J 929000AC AEROSOL CANS (55 GAL.) <br /> Q 929000BF BRAKE FLUID (55 GAL.) <br /> 929000BS BRAKE SHAVINGS (30-GAL.) <br /> LO <br /> LO 8NREGT EMPTY GAS TANKS (55 GAL.) <br /> Q 9DO0155 MIXED FUELS(GAS/DIESEL) (55 GAL.) <br /> J 9ORS005 OILY RAGS (55 GAL.) <br /> 0 90SLO55 OILY SLUDGE (55 GAL.) <br /> *6 9F00355 PAINTED RELATED MATERIAL-LIQUID (55 GAL.) <br /> Z 22211055 USED OIL FILTERS-METAL(NOT DRAINED) (55 GAL.) <br /> � 23523055 USED OIL FILTERS-PAPER (55 GAL.) <br /> Z (°3 22211155 USED OIL FILTERS-CRUSHED (55 GAL.) <br /> ?, LLI MRCRA MANIFEST FEE-RCRA WASTE <br /> LU N MNRCRA MANIFEST FEE-NON-RCRA WASTE <br /> ZLU <br /> "Any Non-Conforming Waste Subject to Additional Charges. <br /> ILL <br /> EMPTY REPLACEMENT DRUMS <br /> > Q 550TFF OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR USED OIL FILTERS No Charge 0.00 <br /> J 550TWB OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR WASTES <br /> O 55CTWB CLOSED TOP(55 GAL.)DRUM-REPLACEMENT OF WASTE <br /> U PARTS WASHER SERVICE <br /> Z 12BWRS BRAKE WASHER RENTAL UNIT(12-GAL.)PORTABLE AIR OPERATED <br /> W30PWRS PARTS WASHER RENTAL UNIT(30-GAL.)DRUM MOUNT <br /> J SCS- SCS POWERSTAR PARTS WASHER SERVICE-CUSTOMER OWNED MACHINE <br /> 0 <br /> Z PSC- POWERSTAR SOLUTION <br /> 0 MANPW PARTS WASHER OIL WATER NIANIFEST# <br /> —i PRODUCTS <br /> Q <br /> (� CCGRN55 <br /> UJ CCGLD55 CLEAN COOL GOLD RECYCLED 50/50 EXTENDED LIFE,UNIVERSAL (55 GAL.) <br /> a <br /> N 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 /> Driver/Serviced By: Date: <br />