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w�■ �� l � v,l-1Fr <br /> 582Q Martin e <br /> Road ►rwrndale. CA 9t7ru <br /> � �: 1 aaa-sir-QFfl.,wwu►..,_ <br /> i Corporate Office <br /> SERVICE WORK t <br /> C'�nT0 5820 Martin Road• Irwindale, CA 91706 ORDER <br /> ' Phone: 1-800-531-9683 41 <br /> i WWW.cleantechenv.com 473633 <br /> WASTE RECYCLING RECEIPT • BULK FLUIDS Die <br /> SALES OFFICE: ❑ Fresno ❑ Irwindale ❑ Newark Ld Sacramento J San Diego <br /> . Name <br /> Customer Purchase Order# <br /> Address Safes Representative <br /> City State Zip ., Phone# <br /> EPA ID # _, Ck#!COD <br /> Manifest# Used Oil —� Manifest#Non Haz Wastewater <br /> Manifest # Used Antifreeze <br /> SHIPPING INFORMATION sue <br /> 0 PART# U.S.DOT SHIPPING DESCRIPTION OTy.,UOM INT PRICE SUBTOTAL <br /> t 100221D0 USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 221 t GAL <br /> Lu <br /> Z 10013SOO USED ANTI-FREEZE NON•RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 135 GAL <br /> LU <br /> L7 GAL <br /> 100430DO NON-HAZARDOUS WASTEWATER <br /> O Milan.Fee MANIFEST DOCUMENT FEE 1 EA. c <br /> . W <br /> H <br /> W <br /> J <br /> O <br /> GENERATOR USED OIL CERTIFICATION 1rn <br /> ca <br /> r <br /> w USED pll CERTIFICATION:Any used ail that the transporter receives from the generator Will be transported t9 a certified used oil recycling ed <br /> °° facility that is lawfuuy operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare Dr <br /> 0 that the Contents of this consignment are fully and accurately described above by the proper DOT shipping name and are classified,packaged, 227 <br /> marked,labeled and are in all aspects in proper condition for transport by D-O.T.standards.All relevant information regarding known or Rbe <br /> suspect hazards associated with this waste have been disclosed. I certify that the waste minimization statement identified in 40 CFR 26227 <br /> {a} (if I am a large quantity generator)or (b) (if I am a small quantity generator) us true. Waste materials which are discovered to be <br /> non-conforming will be subject to additional charges. <br /> Y - <br /> x <br /> TYPE OR PRINT FULL NAME <br /> GENERATOR SIGNATURE DATE <br /> 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 hack of <br /> ¢l# this farm.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 ether waste streams-As the Generator, I acknowledge that our site EPA ID I is active and Cleanfech to <br /> sign as agent on the generator waste prattle rrarksheet for this wastestream(s)designated for the CleanTech facility.This document serves <br /> as a written verification that the waste stream(s)descriptions and constituents found above are unchanged per the Facility Generator Waste <br /> Profile Worksheet and also as the annual <br /> uali written <br /> true verification and for <br /> the <br /> generator waste stream profile worksheet of these waste streams.I declare <br /> under the penalty of perjury t foregoing correct. <br /> CleanTech Environmental, Inc. pRl FULL NAME e" <br /> cc <br /> 5820 Martin Road x �r . <br /> N Irwindale, CA 91706 DRIVER'S SIGNATURE <br /> �r{ a EPA ID #: CAR000330019 <br /> f� F F- TANKER* DATE <br /> RECEIVING FACILITY <br /> LU checked box is the designated recycling facility- <br /> ❑ CleanTech Environmental,Inc. 5820 Martin Road, Irwindale,CA 91706 EPA 1D#:CAL000330453 <br /> 2 v ❑ CleanTech Environmental,Inc.-4910 Donovan Way, Ste.A, N.Las Vegas,NV 89801 EPA ID#:NVR000090050 <br /> W a L' Lj Southwest Processors-4120 Bandini ROLIvard,Verrtan, CA 91508 EPA ID#:CAL921646037 1 <br /> a. <br /> ---...--curui 11 aoufvar -''dy, Ste.q `'t 9T- tW'M ID#:CAL000330453 <br /> - T d'Vernon, CA 915 as Vegas.NV 89801 EPA ID#:NVR00009 f <br />