Laserfiche WebLink
SERVICE WORK <br /> ORDER <br /> §eanyech <br /> Environmental Inc. 32189? <br /> I� 2581 S. Sunland Avenue • Fresno, CA 93725 <br />• ` Phone: 1-800-531-9683 <br /> I : I <br /> _ . <br /> www.cleantechenv.com <br /> Al�1 <br />�► �_ : . WASTE RECYCLING RECEIPT-BULK FLUIDS I <br /> Name I;',N� >•� Customer Purchase Order# <br />^ f•; Address ;3,fr_+ �,� I,:-.���'t� t::f Sales Representative <br /> .i <br /> City State Zip t eflii CA fis��!2 Phone # l <br /> Ck #/COD <br /> EPA ID # , r:t'ret�:,;•h i�I '. <br /> } f Jc Manifest # Non Haz Wastewater i I <br /> r Manifest # Used Oil �J �i� <br /> .a F_ Manifest # Used Antifreeze <br /> SHIPPING INFORMATION I <br /> tPART# U.S.DOT SHIPPING DESCRIPTION aTY. UOM INT PRICE SUB-TOTAL <br /> 10022100 USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 221 .5 GAL <br /> Z 10013500 USED ANTI-FREEZE NON-RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 135 GAL i <br /> w I ) <br /> y GAL <br /> 10043000 NON-HAZARDOUS WASTEWATER <br /> ra <br /> W <br /> Man.Fee MANIFEST DOCUMENT FEE , EA. <br /> F- <br /> UJI <br /> 7 pis <br /> 1 0 GENERATOR USED OIL CERTIFICATION <br /> UJ USED OIL CERTIFICATION:Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling <br /> 0° facility that is lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act. I hereby declare <br /> that the contents of this consignment are fully and accurately described above by the proper DOT shipping name and are classified,packaged, I I <br /> 1 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 the waste minimization statement identified in 40 CFR 26227 <br /> (a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) us true. Waste materials which are discovered to be <br /> j non-conforming will be subject to additional charges. f <br /> TYPE OR PRINT FULL NAME GENERATOR SIGNATURE DATE <br /> 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 <br /> v 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 comingled with other waste streams.As the Generator, I acknowledge that our site EPA ID#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 /> ti ? I declare under the penalty of perjury that the foregoing is true and correct. <br /> i . . <br /> TRANSPORTER <br /> cc <br /> W <br /> CleanTech Environmental,Inc. _. <br /> Cr PRINT FULL NAME <br /> 0 2581 S. Sunland Avenue <br /> ZFresno, CA 93725 X '�'� <br /> Q EPA ID #:CAL000368136 DRIVER'S SIGNATURE v <br /> Cc <br /> , ( � <br /> TANKER# � DATE <br /> I � <br /> RECEIVING FACILITY <br /> W Z ►}— The checked box is the designated recycling facility. <br /> LU <br /> LU O•CleanTech Environmental,Inc.-5820 Martin Road, Irwindale, CA 91706 EPA ID#:CAL000330453 <br /> � I <br /> v aU L21 CleanTech Environmental,Inc.-4910 Donovan Way, Ste.A, N.Las Vegas, NV 89801 EPA ID#:NVR000090050 <br /> LU LU a `L <br /> D Industial Environmental Services - 13350 Grand Valley Parkway, N.Las Vegas, NV 92126 <br />