Laserfiche WebLink
Corporate office SERVICE WORK <br /> CleanTecf� 5820 Martin Road+ Irwindale, CA 91706 ORDER � <br /> Phone; 1-800-531-9683 <br /> www.cleantechenv.com 473547 <br /> C i <br /> IV u WASTE RECYCLING RECEIPT • BULK FLUIDS <br /> SALES OFFICE: C.] Fresno ❑ Irwindale ❑ Newark acramento ❑ San Diego <br /> Name t Q Customer Purchase Order# <br /> Address Sales Representative <br /> ' City State Zip ' _ �, Phone# <br /> EPA ID# r _ —� Ck#/COD <br /> r ' <br /> Manifest# Used Oil Manifest#Non Haz Wastewater <br /> Manifest#Used Antifreeze <br /> - SHIPPING INFORMATION <br /> cr PART 0 U.S.DOT SHIPPING DESCRIPTION OTY- UOM INT PRICE'SUB-TOTAL <br /> (` cc 10422104 USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 221 GAL i ti <br /> W <br /> Z /4413500 USED ANTI-FREEZE NON-RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 135 GAL <br /> W <br /> 1OD43DOO NON-HAZAR DOUS WASTEWATER CAL <br /> m <br /> LU Men.Fee MANIFEST DOCUMENT FEE EA { <br /> yy LU 1 <br /> Ii 1L t, <br /> GENERATOR USED OIL CERTIFICATION <br /> LU USED OIL CERTIFICA710N,Any used oil that the transporter receives hem the generator will be transported t4 a certified used oil recycling <br /> 10 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 alis Consignment are fully and accurately described above by the proper DOT shipping name and are classified,packaged, <br /> marked,labeted and are in all aspeets in pr4pef condition for transport by D.O.T.standards.AU relevant information regarding known or �- <br /> suspect hazards associated with this waste have been disclosed.I certify that the waste minimisation 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 /> Iron-conforming will be subject to additional charges. y t <br /> i <br /> X <br /> TYPE OR PRINT FULL NAME GENERATOR SIGNATURE 12ATE <br /> w i hereby Certify that I tiave read and have tate authority to bind the above listed generator to the terms found an the iront and the back of k <br /> this form. I hereby certify this,and all attached dnuments 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 and CleanTech to <br /> sign as agent on the generator waste profile worksheet for this wastestream(s)designated for the CleanTech facility.This document serves <br /> as a written verification that the waste stream(s)descriptions and constituents found above are unchanged per the Facility Generator Waste <br /> Profile Worksheet and also as the annual written verification for the generator waste stream profile worksheet of these waste streams.I declare <br /> under the penalty of perjury that the foregoing is true and correct. <br /> TRANSPORTER <br /> cc <br /> Lu <br /> CleanTech Environmental,Inc. pRIHT]Fi it 9 NAME`- <br /> '''"� f <br /> O 5820 Martin Road <br /> 0 Irwindale,CA 91706 X � <br /> 2 D I SI NATURE T_— <br /> r ¢ EPA ID #:CAR000330019 r , <br /> . TANKER M DA <br /> RECEIVING FACILITYUJ e <br /> } The Checked box IS the 6esignated recycling facility. <br /> w J Q--CleanTech Environmental,Inc--5820 Marlin Road,Irwindale,CA 91706 EPA ID c CALOOMD453 <br /> CC 0 CleanTech Environmental,Inc--4910 Donovan Way,Ste.A,N.Las Vegas,NV 89801 EPA ID#;NVROOOO90050 <br /> CL CC ❑ Southwest Processors-4120 Bandini Boulvard,Vernon,CA 91508 EPA ID#:CAL921646037 <br />