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I n rar rrrrttllllEY <br /> Corporate Office SERVICE WORK <br /> Cl��T��� EPA ID#; CAL000330453 ORDER <br /> ` 5820 Martin Dodd • Irwindale, CA 91706 r <br /> Environm Phone: 1-800-531-9853 ry <br /> www.cleantechenv.com <br /> SERVICE WORK ORDER <br /> SALES OFFICE: ❑ Fresno ❑ Irwindale ❑ Newark P Sacramento J San Diego � <br /> qNa,me L<'iVo% I 11Va1 titntl% No h:,'c Customer Purchase Order # <br /> ress 1+arar� N Vht�itnli Rn Sales Representative C <br /> Y State Zip Loth CA 96242 Phone #A ID# Ck#J GOs]NON-RC5JRCRA WASTE <br /> RT# DESCRIPTION MANIFEST# QTY. UNIT PRICE SUB-TOTAL <br /> ' 23523155 ABSORBENT MATERIALS (55 GAL) <br /> _j 9290{IOAC AEROSOL CARS (55 GAL.) <br /> Q 92NOOBF BRAKE FLUID (55 GAL.) <br /> 929000B5 SRAKESHAVINGS (30-GAL.) <br /> LBNREGT EMPTY GASTANKS (55 GAL.) <br />� I'1 IM 9DO0155 MIXED FUELS(GAS I DIESEL) (55 GAL.) SOO <br /> O 9ORse05 OILY RAGS (55 GAL.) <br /> 7 90SLO55 OILY SLUDGE (S5 GAL.) <br /> 9F00355 PAINTED RELATED MATERIAL-LIQUID (55 GAL.) <br /> W22211055 USED OIL FILTERS-METAL(NOT DRAINED) (55 GAL.) <br /> 23523455 USED OIL FILTERS-PAPER (55 GAL) �a LI t i . r <br /> Zt;'3 22211155 USED OIL FILTERS-CRUSHED (55 GAL.) <br /> r MRCRA MANIFEST FEE•RCRA WASTE <br /> W N MNRCRA MANIFEST FEE-NON-RCRA WASTE wt i U I <br /> Zo LU <br /> t cc 'Any Non-Conforming Waste Sub)W to Additional Charges.LIL <br /> �} <br /> W EMPTY REPLACEMENT DRUMS li <br /> Z 55OTFF OPENTOP($5 GAL.)DRUM-REPLACEMENT DRUM FOR USED OIL FILTERS No Char a 4.00 <br /> Q 55OTW9 OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR WASTES 470 <br /> 55CTWB CLOSED TOP(55 GAL.)DRUM-REPLACEMENT OF WASTE I f <br /> 0 PARTS WASHEFf SERVICE <br /> r Q12BWRS BRAKE WASHER RENTAL UNIT(12 GAL.}PORTABLE AIR OPERATED <br /> LV 3OPWRS PARTS WASHER RENTAL UNIT(30-GAL.)DRUM MOUNT <br /> J SCS. SCS POWERSTAR PARTS WASHER SERVICE-CUSTOMER OWNED MACHINE <br /> ' Z PSC- POWERSTAR SOLUTION <br /> MANPW PARTS WASHER OIL WATER MANIFESTO <br /> J PRODUCTS <br /> CCGRN55 CLEAN COOL-GREEN 50150 HEAVY DUTY 55 GAL. <br /> IJ.1 CCGLO55 CLEAN COOL GOLD RECYCLED 50150 EXTENDED LIFE,UNIVERSAL 55 GAL. <br /> CL <br /> N UAP100 UNIVERSAL ABSORBENT PADS- 100 PADS PER BUNDLE <br /> UASO30 UNIVERSAL-SOCK- 30 PER PACK <br /> As rhe Generator,I acknowledge that aur sits E?A ID►is acilve and if needed CleanTech to sign as agerd on the Generator Waste Profile Worksheet far this <br /> �r* wastestreamis).This document serves as a written verification that the waste stream(s)descriptions and cunstlluents Lound above are unchanged per <br /> v the Facility Generaror Waste Prolile Worksheet and also as the annual written verl}icalon for the generator waste stream profile worksheet of these waste <br /> streams.I declare under the perAlty of perlurythat the foregoing Is true and cdrrud. <br /> i <br /> Customer Print Name: '` L <br /> 4 Customer Signature. Daft. r*} <br /> Driver lServiced8 <br /> €M <br />