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Corporate Office SERVICE WORK 5820 Martin Road • Irwindale, CA 91706 ORDER CleanTech phone: 1-800-531-9683 www.cleantechenv.com 411162 WASTE RECYCLING RECEIPT • BULK FLUIDS SALES OFFICE: Lff Fresno ❑ Irwindale ❑ Newark ❑ Sacramento ❑ San Diego Name wNOt IV UG ir�c�s �Q/ Customer Purchase Order# Address Sales Representative City State Zip R, uy` Coco Phone# EPA ID # C*rL000L --7-ubD_7- Ck#/COD Manifest# Used Oil e-AU U Lt7v 5 Manifest# Non Haz Wastewater Manifest# Used Antifreeze SHIPPING INFORMATION cc PART# U.S.DOT SHIPPING DESCRIPTION QTY, UOM INTI PRICE I SUB-TOTAL 10022100 USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 221 I � GAL C) W W 10013500 USED ANTI-FREEZE NON-RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 135 GAL C7 } 10043000 NON-HAZARDOUS WASTEWATER GAL m In W Man.Fee MANIFEST DOCUMENT FEE I EA. I.- Lu J IL GENERATOR USED OIL CERTIFICATION w� USED OIL CERTIFICATION:Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling facility that is lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act. I hereby declare that the contents of this consignment are fully and accurately described above by the proper DOT shipping name and are classified,packaged, marked, labeled and are in all aspects in proper condition for transport by D.O.T. standards. All relevant information regarding known or suspect hazards associated with this waste have been disclosed. I certify that the waste.minimization statement identified in 40 CFR 26227 (a) (if I am a large quantity generator) or (b) (if I am a small quantiiv generator us true. Waste materials which are discovered to be non-conforming will be subject to additional charges. f` TYPE OR PRINT FULL NAME GENERATOR SI,G NATURE DATE I hereby certify that I have read and have the authority to bind the above listed generator to the terms found on the front and the back of this form. I hereby certify this, and all attached documents contain true and accurate descriptions of the waste including that the waste is segregated and not comingled with other waste streams.As the Generator, I acknowledge that our site EPA ID#is active and CleanTech to sign as agent on the generator waste profile worksheet for this wastestream(s) designated for the CleanTech facility.This document serves as a written verification that the waste stream(s)descriptions and constituents found above are unchanged per the Facility Generator Waste Profile Worksheet and also as the annual written verification for the generator waste stream profile worksheet of these waste streams.I declare under the penalty of perjury that the foregoing is true and correct. TRANSPORTER cc w 4Wf1' -,1Ai. MU Ct f CleanTech Environmental,Inc. J 2 P T FULL NAME O 5820 Martin Road ZIrwindale, CA 91706 Z EPA ID#: CAR000330019 n 1 R'S SIGNATURE TANKER# 3665 DATE o O RECEIVING FACILITY w kTie checked box is the designated recycling facility. W ' &CleanTech Environmental,Inc.-5820 Martin Road, Irwindale, CA 91706 EPA ID#:CAL000330453 M w LL ❑ CleanTech Environmental,Inc.-4910 Donovan Way, Ste.A, N.Las Vegas,NV 89801 EPA ID#:NVR000090050 CL ❑ Southwest Processors 4120 Bandini Boulvard,Vernon, CA 91508 EPA ID#:CAL921646037