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..�nmG1..Y. 1� Corporate Office iERVICE WORK - —� ClednTeCh 5820 Martin Road• Irwindale, CA 917nc no++�•+ Phone: f 8nn-s�i_n�o� SERVICE WORK Corporate Office ORDER fi ' C1eanTorh 5820 Martin Road• Irwindale, CA 91706 r Phone: 1.800-531-9683 480014 www.c lea ntec h env.c a rn WASTE RECYCLING RECEIPT - BU K FLUIDS SALES OFFICE: ❑ Fresno ElIrwindale U Newark dd Sacramento 0 son Diego 40 Name Customer Purchase Order 4 Address Sales Representative City State Zip ti tf 1 Phone# EPA ID# r 1 L- Ck#rCOD � Manifest# Used oily L j t Manifest# Nan Ffaz Wastewater - Manifest# Used Antifreeze SHIPPING INFORMATION Cr PART# U.S.DOT SHIPPING DESCRIPTION CITY. UOM INT PRICE SUB-TOTAL A'1 1 Q 1 D0221 00 USED OIL NON RC RA HAZARDOUS wASTE LIOUI0,CA WASTE CODE 221 �.,�� GAL w GAL f , 2 10013500 USED ANTI-FREEZE NON-RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 135 11J i >_ 10043GOO NON-HAZARDOUSWASTEWATER r GAL * a0 y� 0 Ulan-Fee MANIFEST DOCUMENT FEE EA. UJ W CL 0 o GENERATOR USED OIL CERTIFICATION rs1 USED OIL CERTIFICATION:Any used oil that the transporter receives Irom the generator will he transported to a certsfied used oil recycling ao e facilities permit issued pursuant to the Federal Act"I hereby declare facility that is lawfully operating in accordance with a hazardous wast r that the contents of this consignment are fully and accurately described above by the proper D07 shipping name and are classified,packaged, marked, labeled and are In all aspects in proper condition for transport by O.D.T.standards. All relevant information regarding known or suspect hazards associated with this waste have been disclosed.I certity that the waste minimization statement identified in 40 GFR 26227 {a} (if I am a large quantity generator) or I61 (if I am a small quantity generator) us true. Waste materials which are discovered to he non-conforming will be subject to additional charges- yy y - X .r GENERATOR SIGNATURE DATE TYPE OR P INT FULL NAME 'r I hereby certify that I have read and have the authority to 4ind the above listed generator to the terms found on the front and the hack of this farm. 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,l acknowledge that our site EPA 1D#is active and CleanTech to sign as agent on the generator waste profile worksheet for this wamestream{s)designated for the CleanTech facility.This document serves 4 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. I TRANSPORTERUJI -� I H CleanTech Environmental,Inc. PRINT FULL 11AME r O 5820 Martin Road ran Irwindale, CA 91708 DRYER sl ATURE EPA ID #; CAR000330019 TANKER N DATE ; * o RECEIVING FACILITY The checked 4ox is the designated recycling facility- Q ❑ ❑ CleanTech t nvironrnental,Inc.-5820 Martin Road, Irwindale,CA 91706 EPA ID#:CAL000330453 Cc tW.t' a ❑ CleanTech Environmental,Inc--4910 Donovan Way,Ste.A,N.Las Vegas,NV 89801 EPA ID# NVR000090050 F u LL ❑ Southwest Processors-4120 Bandini Boulvard,Vernon,CA 91508 EPA ID#:CAL921646037 -;T _a�MLJ 3Lw _ �y,Sze.A, N.Las Ve a%ISV 89BOi EPA ID#:NVR000090050 A _ boulvard,Vernon,CA 91508 EPA IQ#',CAL921646037