Laserfiche WebLink
D SERVICE WORK <br /> Cle a n Te ch ORDER <br /> Environmental Inc. 33974 <br /> - 2581 S. Sunland Avenue• Fresno, CA 93725 <br /> Phone: 1-800-531-9683 <br /> www.cleantechenv.com <br /> WASTE RECYCLING RECEIPT-BULK FLUIDS C <br /> - Name I_rr IC� 1-rnVe-1 '_'1f0!35 i O 5:ftt Customer Purchase Order# <br /> D Address r• r Sales Representative r,F <br /> .1.s1��f IJIfnstati Zen' . , <br />- .�. <br /> City State Zip 1015 CA 95242 Phone# <br /> EPA ID# CAR0602 4,1,1 T4 Gk#1 COD <br />�l Manifest# Used Oil q3 Manifest# Non Haz Wastewater C <br /> Manifest# Used Antifreeze i <br /> SHIPPING INFORMATION C <br /> a: PART# U.S.DOT SHIPPING DESCRIPTION QTY. UOM IN T PRICE SUB-TOTAL <br /> y ;: 10022100 USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 221 GAL <br /> W 10013500 USED ANTI-FREEZE NON•RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 135 GAL <br /> 10043000 NON-HAZARDOUS WASTEWATER GAL i <br /> 1- ID <br /> Man.Fee MANIFEST DOCUMENT FEE EA. C� <br /> f <br /> p GENERATOR USED OIL CERTIFICATION 0 <br /> U V <br /> �•' wal USED OIL CERTIFICATION:Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling <br /> facility that is lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare <br />^4 <br /> that the contents of this consignment are fully and accurately described above by the proper DOT 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 or <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 l <br />.. non-conforming will be subject to additional charges. <br /> TYPE OR PRINT FULL NAME GENERATO�1 SI A URE DATE I <br /> .{. 0h <br />(1 I hereby certify that I have read and have the authority to bin the abov rs ed generator to the terms found on the front and the back of <br /> this form.1 hereby certify this,and all attached documents contain true and accurate descriptions of the waste including that the waste is 1111 y <br /> segregated and not comingled with other waste streams.As the Generator. I acknowledge that our site EPA[D#is active.This document <br /> 1' 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. I <br /> I declare under the penalty of perjury that the foregoing is true and correct. II <br /> TRANSPORTERI(A { <br /> CleanTech Environmental,Inc. r�� <br /> PRINT FU L NAME <br /> • 0 2581 S.Sunland Avenue <br /> ' M Fresno, CA 93725 ,� ^�� � - <br /> Z RIVER'S SIGNATURE <br /> a EPA I D#:CALOOO 88136 <br /> TANKER If DATE <br /> RECEIVING FACILITY <br /> w I <br /> — The checked box is the designated recycling facility. <br /> J YC1eanTech Environmental,Inc.-5820 Martin Road, Irwindale, CA 91706 EPA ID#;CAL000330453 <br /> w — <br /> ' cc w 4 d CleanTech Environmental,Inc.-4910 Donovan Way,Ste.A,N.Las Vegas, NV 89801 EPA ID#;NVR000090050 <br /> I ; a a: � p Industial Environmental Services-13350 Grand Valley Parkway, N.Las Vegas, NV 92126 <br /> .1 <br /> �;,�lj�;+�,�il�,��„`�: ��,..; �,� . ` FYI =}�� - • � . `�' . - .. • � :�� . ' ,,•- <br />