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Corporate Office iERVICE WORK <br /> _. <br /> CieanTech 5820 Martin Fload• Irwindale, CA 917+nP non—. <br /> Phone: 1-Ann-s2+_n�o� <br /> � � SERVICE WORK <br /> Corporate Office ORDER <br /> CI <br /> an5820 Martin Road• Irwindale, CA 91706 <br /> Phone: 1-800-531-9683 480014 <br /> - www.Gleantecheriv.cOm <br /> WASTE RECYCLING RECEIPT • BU�.K FLUIDS <br /> SALES OFFICE: LI Fresno ❑ Irwindale ❑ Newark [d� Sacramento Ll San Diego <br /> Name y customer Purchase Order ig <br /> Sales Representative <br /> Address <br /> City State Zip C I 1 Phone# � — <br /> EPA ID# ,, w Ck#J COD pill <br /> Manifest# Used Oil r.� +`� :j .i Manifest#Non Haz Wastewater <br /> Manifest# Used Antifreeze <br /> SHIPPING INFORMATION i <br /> .� Cr PART# U.S.DOT SHIPPING DFSCRIPTION CITY. IJOM INT PRICE 5Uf3-TOTAL <br /> �1 10022100 USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 221 GAL <br /> 2 1067 3500 USED ANTI-FRE=EZE NON-RCRA MA2ARDOUS WASTE LIQUID,CA WASTE CODE 135 GAL <br /> LU <br /> i 10043000 NON-HAZARQOUSWASTEWATER t GAL <br /> r� <br /> W <br /> Man-Fee MANIFEST DOCUMENT FEE EA. . <br /> W <br /> J <br /> _ GENERATOR USED OIL CERTIFICATION <br /> U <br /> LU USED OIL CERTIFICATION:Any used oil that the transporter receives from the generator well be transported to a certfied used oil recycling <br /> m facility that is lawfully operating in accordance with a hazardous viaste facilities permit issued pursuant to the Federal Act-I hereby declare <br /> that the Contents of this consignment are sully and accurately described above by the proper DOT shipping name and are classified,packaged, <br /> ~ 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 25227 <br /> (a) (if I am a large guanfity generator) -Dr (b) (if I am a small quantity generator) us true. Waste materials which are dlSCnvered to be <br /> non-conforming will be subject to additional charges- <br /> T X <br /> 1- DATE <br /> PE <br /> i <br /> TYPE OR PAINT FULL NAME GENERATOR SIGNATURE <br /> I hereby certify that I have read and have the authority to bind the above listed generator to the terms found an the front and the back of <br /> this farm. 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,1 acknowledge that our site EPA 1D 0 is active and(;ieanTech to <br /> sign as agent on the generator waste profile worksheet for this wastestream{s)designated for the CleanTech facility.This document serves <br /> 4 as a written verification that the waste stream(s)descriptions and constituents found above are unchanged per the Facility Generator Waste <br /> Profile <br /> Worksheet <br /> and <br /> also <br /> y that the foregoing Is trua f and coorethe generator waste stream profile worksheet of these Waste streams.l declare <br /> undtpenalty of <br /> l I TRANSPORTER <br /> LU <br /> CleanTech Environmental,Inc. PRINT FULL NAME y <br /> 0 5820 Martin Roadi6r <br /> r(n Irwindale, CA 91706 D <br /> - RIyE4i SIGNATURE <br /> ZEPA ID #; CAR000330019 r r <br /> h <br /> TANKER# DATE <br /> RECEIVING FACILITY <br /> LIJ FIJ 7 The checked box is the designated recycling facility. <br /> � ❑ CieanTech Environmental,Inc.-5820 Martin Road, Irwindale,CA 91708 EPA tD#:CAL000330453 <br /> Cr U a ❑ CleanTech Environmental,Inc.-4910 Donovan Way,Ste.A,N,Las Vegas,NV 139801 EPA ID#:NVR000090050 ' <br /> X LL ❑ Southwest Processors-4120 Bandini Boulvard,Vernon,CA 91508 EPA IQ#:CAL921646037 <br /> •may,tee•A, N.Las Ve as,PiV 891301 EPA ID#:NVR000090050 <br /> O w .__,..n,11b0UIVard,Vernon,CA 91508 EPA IIJ#•,CAL921646037 <br />