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SERVICEURN 44 S <br /> i <br /> . ' NWORK <br /> CleanTech = i s>�>� <br /> } <br /> Environmental Inc. <br /> 2581 S.Sunland Avenue•Fresno, CA 93725 <br /> l Phone: 1-80❑ 531 9ti83 <br /> l www.cleantechenw.corn <br /> WASTE RECYCLING RECEIPT-BULK FLUIDS <br /> - Name %r:,►,c OVA•,.;n <br /> r Customer Purchase Order# <br /> If k y■ Address <br /> �` ►1 Sales Representative <br /> City State zip <br /> EPA ID# Phone# <br /> -' �— -- Ck#f COD <br /> + Manifest#Used oil <br /> ►� Manifest#Non Haz Wastewater <br /> Manifest# Used Antifreeze <br /> SHIPPING INFORMATION <br /> PART# U,S.DOT SHIPPING DESCRIPTION <br /> CITY. UOM iNT PRICE;SUET-TOTAL <br /> �+ a Ill 1002210D USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CoDfc Z21iu Qpl l <br /> 100135DO USED ANTI-FREEZE NON-RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 13S GAL <br /> >_ 10043000 NON-MAZARDOUSWASTEWATER m GAL <br /> W Aftn.Fs+ MANIFEST DOCUMENT FEE <br /> EA. <br /> o GENERATOR USED OIL CERTIFICATION <br /> ca <br /> w USED OIL CERTIFICATION:Any used oil That the transporter receives from the generator will be transported to a certilied used oil recycling <br /> p facility that is lawfully operating in accordance with a hazardous waste facilitles permit issued pursuant to the Federal Act.I hereby declare <br /> F that the contents of this consignment are fully and accurately described above by the proper CLOT shipping name and are classified,packaged. <br /> marked, labeled and are in all aspects in proper condition for transport by D.O.T.standards-All relevant Information regarding known er <br /> suspect hazards associated with this waste have been disclosed.1 certify that the waste minimizalion statement identified in 44 CFR 26227 <br /> (a) (if I am a Jorge quantity generator) or (b) (if I am a small quantlty generator) us true- Waste materials which are discovered to be <br /> �f non-conforming willpe subject to additional charges. <br /> �i TYPE OR PRINT FULL NAME GENERATOR SIGNATURE DATE <br /> I hereby certify that I have read and have the authority to bind the above listed generator io the terms found an the front and She back of <br /> this form. I hereby certify this,and all attached documents 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 uVr site EPA ID I)is active.This document <br /> serves as a written verification that the waste stream(s)descriptions and constituents found above are unchanged per the Facility Generator <br /> Waste Profile Worksheet and also as the annual written verification for the generator waste stream profile worksheet of these waste streams. <br /> I declare under[be penalty of perjury that the foregoing is true and correct. <br /> TRANSPORTER <br /> CieanTech Environmental,Inc. <br /> PRINT FULL NAME <br /> 2581 S. Sunland Avenue <br /> = Fresno, CA 93725 It <br /> EPA ID N: CALO 0368136 DRIV-ER'S WaNA URE <br /> TANKER DATE <br /> RECEIVING FACILITN <br /> Th <br /> eecked box is the designated recycling facility. <br /> anTech Environmental,Inc.-5820 Martin Road, Irwindale,CA 91706 EPA ID A:CAL0D0330453 <br /> artTsch Environmental,Inc. .4910 Donovan Way, Ste.A, N.Las Vegas, NV 89801 EPA 1D M:NVROD00900M <br /> A [CLustiaf Environmental Services• 13350 Grand Valley Parkway, N.Las Vegas, NV 92126 <br /> lam. <br />