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SERVICE WORK <br /> 1 Corporate Office ORDER � <br /> } EPA ID#:CAL000330453 <br /> r ' <br /> . CleanTe�h 580 Martin Road • Irwindale, C <br /> Environmental Inc. Phone; 1-800-531-9683 A 1706 739893 <br /> p www.Cleantechenv.com if <br /> SERVICE IiN �� <br /> SALES OFFICE: ❑ Fresno LJIrinrindale CRK 080E Sacramento El San Diego <br /> 5a <br /> ❑ Newark <br /> Name Loves Travel Stops No 638 i GL6tflrnQr purchase Order# <br /> t <br /> Address 152so N Thorton Rd <br /> Representative a resentatirle C5 <br /> 5aies <br /> Cit'State Zip LM+it CA %- 242 <br /> Phone# '!. 3 q <br /> I EPA ID# C:AR(H 024117-1 sky;COD <br /> 1Ir NON-RCRAIRCRA WASTE <br /> [yI PART# DESCRIPTION MANIFEST# C)TY. UNIT PRICE SUB-TOTAL ., <br /> 9 f 23523155 ABSORBENT MATERIALS (55 GAL.) �} <br /> _J 929WAC AEROSOL CANS (55 GAL.) <br /> Q 929000BF BRAKE FLUID (55 GAL.) <br /> LO 929MOBS BRAKE SHAVINGS (30-GAL.) Ilia." <br /> 1 SNREGT EMPTY GAS TANKS (55 GAL.) <br /> O 9DD0155 Ml%ED FUELS(GAS 1 DIESEL) (55 GAL.) <br /> J <br /> ❑ 9ORS005 OILY RAGS (55 GAL.) <br /> f ❑ 90SLO55 OILY SLUDGE (55 GAL.) <br /> 05 9F00355 PAINTED RELATED MATERIAL-LIQUID (55 GAL.) <br /> 4 W 22211055 USED OIL FILTERS-METAL(NOT DRAINED) (55 GAL.) <br /> Z1X: 23523055 USED OIL FILTERS PAPER (55 GAL.) 7 L -7 } <br /> 2.2211155 USED OIL FILTERS-CRUSHED (55 GAL.) <br /> r MRCAA MANIFEST FEE-RCRA WASTE <br /> W <br /> LUN MNRCRA MANIFEST FEE-NON-RCRA WASTE + <br /> W <br /> _ 0 W <br /> Any Non-Conforming Waste Subject to Additional Charges. <br /> Lt <br /> h. EMPTY R LAQWNT DRUMS <br /> > 2Q 55OTFF OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR USED OIL FILTERS No Charge 0.00 <br /> � J 55OTWB OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR WASTES <br /> d55CTWB- CLOSED TOP(55GAL)DRUM-REPLACEMENT_OFWAVE ;. <br /> U PARTS WASHER SERVICE <br /> Q12BWRS BRAKE WASHER RENTAL UNIT(12-GAL.)PORTABLE AIR OPERATED <br /> W 30PWRS PARTSWASHER RENTAL UNIT(30-GAL.)DRUM MOUNT <br /> J SCS- SCS POWERSTAR PARTS WASHER SERVICE-CUSTOMER OWNED MACHINE <br /> U <br /> 2 PSC- POWt RSTAR SOLUTION _ <br /> ❑ MANPW PARTS WASHER OIL WATER MANIFESTM <br /> 4 PRODUCTS <br /> V CCGRN55 CLEAN COOL-GREEN 50150 HEAVY DUTY 55 GAL- N <br /> W CCGLD55 CLEAN COOL GOLD RECYCLED 50150 EXTENDED LIFE,UNIVERSAL 55 GAL. <br /> _ a <br /> IlUAP100 UNIVERSAL ABSORBENT PADS- 100 PADS PER BUNDLE <br /> �yx UA5030 UNIVERSAL SOCK- 30 PER PACK r <br /> ff11Y! As the Generator,I aCknowledge that our site EPA!D 0 is active and if needed CleanTech to sin as agent on the Generator Waste I'rotile Worksheet for this ►i F'}!4 <br /> the Facility g Gene)tor Waste Profile servesThis document as e t and alsoritten �alsahe annualtion that hwrittentverlflcatioe stream nSforetheScriPlions and considuents found above are unchanged per <br /> of perjury that the foregoing is true and correct. generator waste stream profile worksheet of these waste <br /> streams.I declare under the penalty Pe I ry 9 <br /> Customer Print Name: <br /> Customer Signature: I _ <br /> Driver lServlred B — <br /> Date.• T <br />