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SERVICE WORK VORK <br /> ORDER <br /> Corporate Office �. <br /> GA 91706 <br /> SCh 5520 Martin Road•Irwindale, 473545 7 <br /> CleanT phone' 1-800-531-9683 <br /> • www.cleantechenv.com <br /> FL <br /> WASTE RECYCLING RECEIPT k B❑Sacramento ❑ son Diego �0� <br /> I'I IrwindaleLlNewar <br /> SALES OFFICE: U Fresno <br /> customer Purchase order# <br /> f1 <br /> Name rSafes Representative <br /> Address ti � l i <br /> j Phone# <br /> city State Zip Ck# <br /> EPA ID# 0 <br /> Manifest#Non Flax Wastewater <br /> Manifest#Used Oil <br /> Manifest#Used Antifreeze <br /> SHIPPING INFORMATION � <br /> l].S-DOT SHIPPING pESCR1PTI0hI QTY- I}QM INT PRICE gug-TtJTRL <br /> a PART# �—— GAL <br /> 4 70x22100 USED 01 NON RCRA HA7ARDOUsWASTE LIQUID.CAWASTE COPE 221 J { <br /> GAL <br /> LIJ /0013500 USED A%T1-FREEZE NDN-RCR <br /> Z A HATAADOU51NA5TE LIOU10,CAIMASTE C4bE t' p ' <br /> ZGAL �1 <br /> m10043000 NON.IIA7ARDOUS wAsnWATER EA. { <br /> Im Man.Fee MANIFEST U0 <br /> OcUMENT FEE r <br /> J <br /> LU <br /> G (GENERATOR USED 011-CERTIFICATION <br /> lled"ed <br /> il <br /> U that 1he <br /> LU USED OIL CERTIF uCATON:Ay m ac colydance w th a ha tfanspnler receives <br /> us waste facilities PPWIl t Issue(om the generator hipping <br /> pursuant 1 be eltna e a Feded to a eral Act t he�eby decla e <br /> W facility that is lawfullyoperating <br /> O that the contents of this consignment are fully and accurately described above by the proper 001 shipping name and are classiI ed,pkni)Wn Or <br /> ackaged, <br /> marked, tabassociaetein all d with aSp8CtS in <br /> s waste haverbeendition for disclosed recertify ort by <br /> the aaledminjm iation statemeninfort idevantlntiied nr 4�0 CFR 26227 <br /> suspect hazardsenerator or {b) (if I am a small quantity generator] us true <br /> •Waste materials which are discovered to 4e <br /> (a)[it l am a large quantity generator) <br /> non-conforming will be subject to additional charges" I <br /> x DATE <br /> TYPE OR PRINT FULL NAME <br /> GENERATOR SIGNATURE <br /> generator to <br /> rms lound <br /> I hereby certify that t have read andfia)je the authority to all attached documentslnd 1[0 contain trrue andaccurateurate descriiptitDns Df thew stelincludingthe tthatdthe w stelhe tack�5 <br /> thi5loTm.l hereby certily this,and <br /> sign r as agent on the genega d wwith <br /> other le worksheet for this treams.As aste sewastestream(s)des gna edtfor the Clean echOf cll ty.This dacum t serves <br /> as a written verifl-Wi❑n that the waste stream{;s)descriptions and constituents found above are unchanged per the facility s,I Waste <br /> Profile Worksheet and also as the astnual written veriticatitnforthe generator waste stream profile worksheet of these waste streams, declare <br /> under the penalty of perjury chat the loregoing is true and correct. <br /> -rRANSPORTER <br /> cc ^ <br /> GteanTech Environmental,Inc- PR NT FULL NA <br /> p 5820 Martin Road <br /> Irwindale,CA 91706 <br /> 4 EPA ID#:CAR000330019 D f1'S SIGNATURE <br /> 7A141tER M DATE 1 <br /> RECEIVING FACILM <br /> W Z The checked box is the designated recycling facility, <br /> w Q C1eanTech Environmental,Inc.-5820 Martin Road,Irwindale CA 9M6 EPA IQ t OALOD0330453 <br /> 0 b CleanTech Environmental,Inc.-4910 Donovan Way,Ste.A,Id.Las Vegas,NV 8981]1 EDA 4D#:NVFIQ04090054 <br /> LUSouthwest PTOCeSSOfS-020 Bandinj 9oulvardNernon,CA 91508 EPA ID#:f AI_921646037 <br /> 4A <br />