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...irflXl{s1�+• - Corporate Office SERVICE WORK CJ a �'�� 5820 Martin Road* Irwindale, CA 91706 ORDER Phone: 1-800-531-9683 www.cleantechenv.com 473561 WASTE RECYCLING RECEIPT - BULK FLUIDS fir• SALES OFFICE; ❑ Fresno 7 Irwindale ❑ Newark f3 Sacramento LLI San Diego r Name Customer Purchase Order# l •� k Address -� r` a. Sales Representative It City State Zip - Phone# EPA IUa�' '.4 �- v r Ck0/COD 0 I Manifest#Used Oil r Manifest#Non Haa Wastewater s cell Manifest#Used Antitreere ii SHIPPING INFORMATION O PART# U.S,DOT SHIPPING DESCRIPTION OTY. UOM IN T PRICE SUg-TpTpL t, Q 100221 DD USED OIL NON RCRA HAZARDOUS WASTE uoUIO,CA WASTE CODE 221 - GAL r _ Lu z f 0013$gp USED ANTI-FREEZE NON-RCRA HAZARDOUS WASTE LIQUID.CA WASTE CODE 135 =� c� GAL :D- 100#31DD0 NON-HA7ARODUSwA$TEWATER GAL Mtn.Fee MANIFEST DOCUMENT FEE W EA. Q GENERATOR USED OIL CERTIFICATION 0 Alt m USED OIL CsRTIFICATIph:Any used oil the[the Transporter receives from the generator will rte transported to a certified Used oil recycling O [acute than is lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare H that the cabeiod ❑f this consignment are fulry and accurately described above by the proper[lOT shipping name and are classified,packaged, marked, labeled and are in all aspects in proper conditiara far transport by 17.p,T.standards,All relevant information regarding known or suspect hararajs ass❑❑iated with this waste have been disc)❑sed.1 certify that the waste minimization statement identified in 40 CFR 26227 (a} {if I or i large qua generator) ar [b} r I am a small quantity generator] us true. Waste materials which are discovered to he non-conforming will he subject to additional charges. • ! TYPE OFr PRINT FULL NAME X a C GENERATOR StCNATURE DATE l hereby g i y certify that!have read and have the authprity to bind the above listedeneratar to the terms found on the front and the back of this form. l hereby certify this,and all attached documents contain true and accurate descriptions of the waste including that the waste is segregated and not comingied with other waste streams.As the Generator,r acknowledge that our site EPA If) is active and CleanTech t0 sign as agent on the generator waste profile worksheet for this wastestream(s)designated for the GleanTech facility.This document serves as a written verification that the waste stream[s]descriptions and constituents found above are unchanged r the Profile Worksheet and also as the annual written verification for the generalorwaste stream profile worksheet o these w stte steams.I declare under the penalty of perjury that the foregoing rs true and correct. ` Q TRANSPORTER lu CleanTech Environmental,Inc. :`. F O Q. 5$20 Martin Road Pkl T FUEL AME V l . i Irwindale, CA 51706 X i cr EPA ID#:CAR000339019 tYER'S 51GNATl1RE _ TANKER�I DATE `— Lu a RECEIVING FACILfrY S The checked box is the designated recycling facility. 203 O CleanTech Environmental,Inc.-5820 Martin Road, Irwindale,CA 91706 EPA 0#:CAL000330453 w 4z ❑ CleanTech Environmental,Inc.•4910 Donovan Way,Ste.A, N.Las Vegas, NV 89801 EPA ID C NVR000090050 i CL ¢ ❑ Southwest Processors.4120 Bandini Boulvard,Vernon, CA 91508 EPA ID#:CAL921646037 TA4IKER f: DATE RECEIVING FACILIT`r ZThe checked txlx is the designated recycling facility. wCleanTech Environmental,Inc.-5820 Martin Road,ttwindate CA 91706 E 11?1M:CAt000 ca CleanTech Environmental,Inc.-4910 Donavan Way,Stu,A.N.Las Vegas !698Q1 EPA IDD C#;NVROOQQ9pp5t] a '6 ❑ Southwest Processors-4120 Dandini Boulvard,Vernon,CA 9 EPA 1()CAL921646037