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Corporate Office iERVICE WORK <br /> 5829 Martin Road•Irwindale,CA 917r1F ORDER <br /> Corporate office <br /> Cl��reCh 5920 Martin Road•Irwindale, CA 91706 SERVICE WORK <br /> ± r Phone: 1-800-531-9683 ORDER � <br /> www_cleantechenv.com # <br /> WASTE RECYCLING RECEIPT • BULK F 476549 <br /> SALES WASTE RECYCLING <br /> ❑ Irwindale FLUIDS �rr � <br /> ❑ Newark ❑Sacramento ❑San Diego 'r <br /> Marne <br /> Address Customer Purchase Order# <br /> safes Representative <br /> City State Zip . <br /> EPA ID# Phone# ! <br /> 1I � <br /> Manifest#Used Oil Ck#1 COD <br /> Manifest#Non Haz Wastewater <br /> Manifest#Used Antifreeze <br /> o PART# SHIPPING INFORMATION r <br /> 3 U.S.r?pT SHIPPfNG dESCRIPTION <br /> R 10022100 USEO O!L N9N RCRA HAIARbOUs WASTE L1QUt0,CA WASTE CODE 221 QTY UOM INT PRICE SUB-TOTAL <br /> Il! <br /> Lu 700t3500 USEO ANTI-FREEZE MOH RCRA HAZARDOUS WASTE Lf4U10,CA WASTE CODE tag GAL <br /> I W <br /> C9 <br /> 10043000 NPN 11 GAL %L <br /> M AZARDOUS WASTEWATER <br /> GAL <br /> W Man.Fee MANIFEST DOCUMENT FEEuJ <br /> -J -- EA. <br /> Y� � <br /> i Y � � yy <br /> 0 GENERATOR USED OIL CERTIFICATION <br /> USEtI TIF <br /> OIL Cs lawfullyICAOperating <br /> :Any used oil that the transporter receives}ram the generator will be transported to a certified used nil recyclingt <br /> facility that is lawlull <br /> l O Y operating in accordance wlfh a hazardous waste facilities permit issued pursuant to the Federal Act,I hereby d <br /> + F- that the contents of this consignment are fully and accurately described above es the mit proper D I <br /> lI marked, labeled and are in all aspects in proper condition for transport by D-D.T.standards.All relevannamet inforan d are mation y eclafe <br /> suspect hazards associated with this waste have been disclosed.I certify that the waste min m zationlstatementidentified lin 40 CFR owned, <br /> (a) [if f am a large quantityregarding known 227 ' <br /> non-Conforming wilt be subject to additional charges. <br /> am a small uanti <br /> G ry generator} us true.Waste materials which are discovered to he <br /> h � <br /> TYPE OR PRINT FULL NAME x } <br /> GENERATI]R SIGNATURE <br /> thereby certify that I have read and have the authority 10 bind the above listed generator to the terms found onn the and the <br /> this Farm. I hereby certify tfris,and all attached documents contain true and accurate descriptions of the waste including that the wage segregated and not comingled with ether waste streams.As the&enerator,l acknowledge that our site EPA IO is active and back of <br /> sign as agent nn the generaf0r waste profile worksheet for[his Wastestream[s]designated for the CleanTech facility.This document Serves v <br /> as f written verification that the waste stream[s]descriptions and constituents found above are e CleaTe Ste is <br /> CleanTech to � <br /> Profile Worksheet and also as theannual written verification for the generator waste stream profile a unchanged <br /> these waste streams-l Waste • <br /> under the penafly 01 perjury that the foregoing is true and correct, per the Facility Generator Waste <br /> f a TRANSPORTER <br /> UJ <br /> CleanTech Environmental, Inc. <br /> O 5820 Martin Road IU <br /> y Irwindale, CA 91708 . <br /> EPA ID#:CARD00330019 x <br /> Q S SIGNATURE <br /> H 1J/7 <br /> TANKER N JLT—_ <br /> GATE <br /> Y RECEIVING FACILITY <br /> F>F- ?e checked box is the designated recycling facility. <br /> F� ; CleanTech Environmental,Inc.-5820 Martin Fuad, Irwindale, CA 917 <br /> � W U <br /> 06 <br /> rx w D Clea n7ech Environmental,Inc.-4910 Donovan Way,Ste.A,N,Las Vegas, 89801 AL000330453 <br /> L" <br /> X ❑ Southwest Processors 4120 Bandinf$pulvarCf <br /> Vernon,CA 91508 EPA lD#:CAL927646p�#'NVR000090050 <br /> _ _ ,,;s�..—•- - - - - __ _ _ _ - ..-..,it,rate. <br /> CA H,tv.Les�vy-.� <br /> w o. r r..,,� �utnl tsoulvard,Vernon, 91508 EPA <br />