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Corporate Office iERVICE WORK <br /> -*�•..-. 5829 Martin Road- Irwindale,CA 917nF ORDER <br /> t - r <br /> Corporate Office <br /> !C'6 ' R <br /> �7E'[�] <br /> 52O Martin Road-Irwindale, CA 91706SERVICE WORK C <br /> • Phone: 1-800-531-9683 - ORDER r i <br /> r www-cleantechenV com � � <br /> 01a a <br /> WASTE RECYCLING RECEIPT BULK F 476549 <br /> SALES OFFICE: ( Fresno LI ❑ <br /> Irwindale FLUIDS <br /> Newark ❑ Sacramento p San Diego 4t <br /> Name <br /> Add. SS Customer Purchase Order# � 0 <br /> City State zip Safes Representative <br /> FPA ID# Phone# • <br /> Manifest#Used Oil Ck# COt7 St <br /> Manifest# S <br /> Used Antifreeze Manifest#Non Haz Wastewater <br /> z o PART# SHIPPING INFORMATION <br /> ¢t- U.S.r?pT SHIPPING DESCFIIPTION <br /> 10Q221Qe USED Oft.NON RCRA NAIARDQUS WASTE L1QU+D CA WASTE CODE 2�1 QN UOM INT PRICE SUB-TOTAL <br /> 11r <br /> W 1DQ13500 USED ANTI-FREEZE NON-KORA HAZARDOUS WASTE Lf4UID, GAL <br /> In> CA WASTE CGDE 135s <br /> 1U043ppD NON-HAZARDOUS WASTEWATER GAL <br /> W Man.FeeGAL <br /> MANIFEST DOCUMENT FEE40 <br /> w <br /> EL <br /> Lu GENERATOR USED OIL CERTIFICATION ' <br /> 0 <br /> 0 uL faCii OIL Cs lawfully open Any used oil that the transporter receives from the generator will be transpaned to a certified used nil recycling h�x <br /> that the <br /> that to lawfully operating in accordance with a hazardous waste facilities permit issued <br /> pu 7 <br />�: + r•- that the contents Df this consignment are fully and accurately described aboversuacl+ Ing <br /> marked, labeled and are d all aspects in proper condition for transport by O-O,T.standards.All eievant intormaGongct.I hereby declare <br /> known or <br /> suspect hazards associated with this waste have been disclosed,I certify bythaDthe.T.stae arft All rel va name and are classified, <br /> packaged, �- <br /> (a! [if f or a large quantity generator}or(b){if I am a small quanti statement identified in40CFR 26227 <br /> non Conforming wilt be subject to additional charges, <br /> ry generator} us true,Waste materials which are discovered to be <br /> TYPE OR ARINT FUEL NAAAE x - -r <br /> tithereby Ceniry[hat t have read and tiave the authority to b nd he aboveGl sAed aE ' <br /> [his Farm.I hereby certify this,and all attached documents contain true and accurate descriptions of the waste <br /> n th ding that the w <br /> generator to the terms found on the front and the back of <br /> segregated and not Camingled with other waste streams.As the Generator,I acknowledge that our site EPA 10 is active and Clean aSt to <br /> sign as agent do the generator waste profile worksheet for this wastestream[sJ designated for the CleanTech EPA <br /> facility.This document serves r <br /> as a written verification that the waste stream[s}descriptions and constituents found shave are hechan Te per serves is <br /> Profile Worksheet and also as Meannual written verification for the generator waste stream profile worksheet of these waste streams.t declare <br /> under the Penalty of perjury that the foregoing is true and correct. g p the Facility Generator Waste 40 <br /> c� TRANSPORTER <br /> ul <br /> CleanTech Environmental,Inc. <br /> 0 5820 Martin Roadr q <br /> I U L M <br /> N Irwindale,CA 91706 <br /> 4 EPA ID#:CAR000330019 x <br /> cc <br /> Q S SIGNATURE I <br /> f— + <br /> TANKER rf <br /> DATE <br /> o Z RECEIVING FACILITY �`I <br /> T e checked box is the designated recycling facility- <br /> J CleanTech Environmental,Inc.-5820 Martin Road,Irwindale,CA 91 <br /> m w l ❑ CleanTech Environmental,Inc.-4910 Donovan 706 EPA ID#:CAL000330453 <br /> a- X ❑ Southwest Processors 4120 Bandini f3oUlvard Way,Ste.R,N,Las Vegas, NV 89801 #:NVRO ID PA ` <br /> Vernon,CA 91508 EPA!D#:CAL921EPA <br /> ID 00090050 <br /> -_ 1- 'A <br /> H,tv.Lds VU9—_ I <br /> `. a a _,.r,���uini tsoulvard,Vernon,CA 91508 EPA{ID <br />