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Corporate Office iERVICE WORK -*�•..-. 5829 Martin Road- Irwindale,CA 917nF ORDER t - r Corporate Office Ct�a ' R �7E'[�] 5p0 Martin Road-Irwindale, CA 91706 SERVICE WORK C • Phone: 1-800-531-9683 - ORDER r i r ►'rww-cleantechenV com � �01a a WASTE RECYCLING RECEIPT BULK F 476549 SALES OFFICE: ( Fresno ❑ ❑ IrwindaleFLUIDS Newark ❑ Sacramento p San f?iegai Name Add. SS Customer Purchase Order# � 0 City State zip Safes Representative EPA ID# Phone# • Manifest#Used Oil Ck# COt7 St Manifest# S Used Antifreeze Manifest#Non Haz Wastewater z o PART# SHIPPING INFORMATION ¢t- U.S.r?pT SHIPPING DESCFIIPTION 10Q221Qe USED Oft.NON RCRA NAIARDQUS WASTE L1QU+D CA WASTE CODE 2�1 QN UOM INT PRICE SUB-TOTAL 11r W 1DQ13500 USED ANTI-FREEZE NON-RCRA HAZARDOUS WASTE Lf4UID, GAL In> CA WASTE CODE 135 s 1U043ppO NON-HAZARDOUS WASTEWATER GAL W Man.Fee GAL MANIFEST DOCUMENT FEE40 w EL Lu GENERATOR USED OIL CERTIFICATION ' 0 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 that the that to lawfully operating in accordance with a hazardous waste facilities permit issued pu 7 �: + r•- that the contents Df this consignment are fully and accurately described aboversuacl+ Ing marked, labeled and are d all aspects in proper condition for transport by O-O,T.standards.All eievant intormaGongct.I hereby declare known or suspect hazards associated with this waste have been disclosed,I certify bytha Dthe.T.stae arft All relevant va name and are classified, packaged, �- (a! [if I or a large quantity generator}or(b){if I am a small quanti statement identified nr4p CFR 26227 non Conforming wilt be subject to additional charges, ry generator} us true,Waste materials which are discovered to be TYPE OR ARINT FUEL NAAAE x - -r tit thereby Ceniry[hat t have read and tiave the authority to b nd he aboveGl sAed aE ' [his Farm.I hereby certify this,and all attached documents contain true and accurate descriptions of the waster h ding that the w generator to the terms found on the front and the back of segregated and not Camingled with other waste streams.As the Generator,I acknowledge that our site EPA 10 is active and Clean aSt to sign as agent do the generator waste profile wprksheet for this wastestream[sJ designated that the CleanTech EPA facility.This document serves r as a written verification that the waste stream[s}descriptions and constituents found shave are hechan Te per serves is Profile he rks Penalty and also as Meannual written verification for the generator waste stream profile wprksheet of these waste streams.t declare 40 under the Penalty of perjury that the foregoing is true and correct. g p the Facility Generator Waste c� TRANSPORTER ul CleanTech Environmental,Inc. 0 5820 Martin Road r q I U L M N Irwindale,CA 91706 4 EPA ID#:CAR000330019 x cc Q S SIGNATURE I f— + TANKER rf DATE o Z RECEIVING FACILITY �`I T e checked box is the designated recycling facilitLU y- J CleanTech Environmental,Inc.-5820 Martin Road,Irwindale,CA 91 m w l ❑ CleanTech Environmental,Inc.-4910 Donovan 706 EPA ID#:CAL000330453 a- X ❑ Southwest Processors 4120 Bandint f3oUlvard Way,Ste.R,N,Las Vegas, NV 89801 #:NVRO ID PA ` Vernon,CA 91508 EPA!D#:CAL921 EPA ID 00090050 -_ 1- 'A H,tv.Lds VU9—_ I `. a a _,.r,��uini tsoulvard,Vernon,CA 9150E EPA{ID