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-17 <br /> SEgVICE WORK <br /> . ORDER <br /> _ CleanTech <br /> Envlronmena! Inc. 32335 i G <br /> 2581 S. Sunland Avenue•Fresno, CA 93725 <br /> Phone: 1-800-531-9683 <br /> I' www.cieantechenvxOm 0 <br /> WASTE RECYCLING RECEIPT-BULK FLUIDS <br /> 1 <br /> 11: Customer Purchase Order# O <br /> d:' Name I -«.5:. ;r:.,..-: 4t�;r,a r;�ko r:.t;e _ <br /> Address ;.,,° :: <br /> s i g t.►n'+ter r-irl Sales Representative t--"s <br /> yy1: ' <br /> city state car,;�,.1 Phone# a <br /> i. tY P t ��r=a l:l\ 4 <br /> Ck#/COD <br /> �:. EPA ID# C,,-:L404it 241 !1 <br /> Manifest#Used Oil a3��1q / 1.�� S Manifest#Non Haz Wastewater <br /> Manifest#Used Antifreeze <br /> �= SHIPPING INFORMATION <br /> -' cc PART# U.S.DOT SHIPPING DESCRIPTION <br /> CITY. <br /> UOM INT PRICE SUB-TOTAL <br /> ;`. O <br /> 10022100 USED OIL NON RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 221 1i GAL r <br /> q . <br /> 1u i0013500 USED ANTI-FREEZE NDtV•RCRA HAZARDOUS WASTE LIQUID,CA WASTE CODE 135 GAL <br /> 1 Z <br /> 1 4'` LU <br /> GAL <br /> 1. 10043000 NON-HAZARDOUS WASTEWATER <br /> EA. 7-� <br /> G Man.Fee MANIFEST DOCUMENT FEE <br /> ' LU <br /> 0— H � �f <br /> •I.- J , <br /> CL <br /> GENERATOR USED OIL CERTIFICATION <br /> f. ' U <br /> m USED OIL CERTIFICATION:Any used oil that the transporler receives from the generator wil be transported to a certified used ail 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 /> I : that the contents at this consignment are fully and accurately described above by the proper DOT shipping name and are classified,packaged, <br />•l marked, labeled and are in all aspects in proper Condition for transport by D.O.T.standards.All relevant information regarding known or I <br /> suspect hazards associated with this waste have been disclosed.I certify that the waste minimization statement identified in�40 CFR 26227 i <br /> (a) (if l am a large quantity generator) ar (b) (if l am a small quantity generator] us true-Waste materials which are discovered to be <br /> non-confvrminq will be subject to additional charges. <br /> U 0 x <br /> GENE RATORSIGNATURE DATE <br /> TypE OR PRINT FULL NAME <br /> III l hereby .I he <br /> tqy that!have read and have the authority to.bind the above listed generator tv the terms found on the front and the back of <br /> this Jorm.1 hereby certify this,and all attached documents contain true and accurate descriptions of the waste including that the waste is <br /> segregated and not comingied with other waste streams.As the Generator,I acknowledge that our site EPA ID#is active.This document i1 <br /> ! serves as a written verification that the waste stream(s)descriptions and constituents found above are unchaPtged per the Facility Generator_ <br /> Waste Profile ten v eel and also as the annual Wjf en verification for the generator waste stream profile worksheet.af these waste streams. <br /> I declare under the penalty of perjury that the foregoing is true and correct. <br /> [, • TRANSPORTER <br /> F CleanTech Environmental,_Inc. PRIN u LI AME <br /> 0p 2581 S.Sunland Avenue <br /> Cn Fresno, CA 93725 fp IVER'S STATURE <br /> x CAL000368i36 <br /> C5 ; : a EPA ID <br /> #: l ir7/ <br /> . . 1 aATE �; <br /> =CleanT - <br /> ER# <br /> r. RECtIVING FACILITY <br /> 4 <br /> -' w is the designated recycling facility. Irwindale,CA 91706 EPA lf�#:CAt_000330453 , <br /> nvironmental,Inc. 5820 Martin Road' #:NVR000090050: : ru — Vv ,Ste-A,N.Las Vegas,NV 89801 EPA 10 jto V4nvironmental,Inc.-4910 Donovan Valle Parkwa ,N.Las Ve as, NV 92126 <br /> "- ironmental Services-13350 Grano <br /> d y y s <br /> a. <br />