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SERVICE WORK <br /> � Corporate office ORDER <br /> � <br /> „�� EPA ID#: CALDDQ33Q45$ <br /> GHQ, r 5820 Martin Road • I rwindale, CA 91706739893 <br /> 1EnvironmentalPhone: 1-800-531-9683 <br /> p www.Cleantechenv.com <br /> SERVICE W �N <br /> SALES OFFICE: ❑ Fresno ❑ h ,Inda I e WORK CRDER Sacramento ❑ San Diego <br /> ❑ Newark <br /> Name Laves Travel Stops No 63g Gustorner purchase Order Ai <br /> i f Address 15260 N Therton Hd Representative CS <br /> des <br />. City State Zip Lr,0i CA oS242 phone# 3 C� <br /> EPA ID# CANOtrv241174 Gkp;COD <br /> * NON-Rc�A�c�A WASTE <br /> n F <br /> RT; DESCRIPTION Mp�jIFEST# L}TY. UNIT PRICE SUBTOTAL <br /> if CC 523155 ABSORBENT MATERIALS (55 GAL.I <br /> _J9000AC AEROSOL CANS (55 GAL.) <br /> Q 929000BF BRAKE FLUID (55 GAL.) <br /> ❑ 92900065 BRAISE SHAVINGS [30 GAL.] i <br /> I <br />- 1 eNREGT EMPTY GASTANKS (55 GAL.) <br /> V 0 9DD0155 MIXED FUELS(GAS!DIESEL) (55 GAL.] <br /> 9ORS005 OILY RAGS (55 GAL.) <br /> ❑ 90SLO55 OILY SLUDGE (55 GAL.) <br /> ad 9F00355 PAINTED RELATED MATERIAL-LIQUID (55 GAL.) . <br /> W22211055 USED OIL FILTERS-METAL(NOT DRAINED) (55 GAL.) f: y <br /> CC23523055 USED OIL FILTERS-PAPER (55 GAL.) 7C 7' <br /> Z 22211155 USED OIL FILTERS-CRUSHED (55 GAL.) <br /> I r MRCRA MANIFEST FEE-RCRA WASTE <br /> ZN MNRCRA MANIFEST FEE-NON-RCRA WASTE <br /> W <br /> o W _ <br /> LPL. Any Non-Conforming Waste Subject to Additional Charges. <br /> LU EMPTY REPLA. 7'DRUMS <br /> Z 55OTFF OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR USED OIL FILTERS No Charge 0.00 <br /> N -J 550TWB OPEN TOP(55 GAL.)DRUM-REPLACEMEN DRUM FOR WASTES <br /> ew; ❑❑ W 5SCTB CLOSEDTOP(55 GAL.)DRUM--REPLACEMENT OF WAVE <br /> r U PARTS WASHER SERVICE <br /> Q12BWRS BRAKE WASHER RENTAL UNIT(12-GAL.)PORTABLE AIR OPERATED <br /> 10 W 3OPWRS PARTS WASHER RENTAL UNIT(30-GAL.)DRUM MOUNT <br /> scs- SCS POWERSTAR PARTS WASHER SERVICE-CUSTOMER OWNED MACHINE <br /> U <br /> I Z PSC- POWERSTAR SOLUTION <br /> ❑ MANPW PARTS WASHER OIL WATER MANIFESTN <br /> J PRODUCTS <br /> L.a CCGRN55 CLEAN COOL-GREEN 5o i 50 HEAVY DUTY 155 GAL.)_n . <br /> W CCGLD55 CLEAN COOL GOLD RECYCLED 50150 EXTENDED LIFE,UNIVERSAL 55 GAL. <br /> a <br /> N UAP100 UNIVERSAL ABSORBENT PADS-J 100 PADS PER BUNDLE _ <br /> y UAS030 UNIVERSAL SOCK- 30 PER PACK <br /> 11 As the Generator,I acknowledge that our site EPA!D is active and if needed CleanTech io sign as agent on the Generator Waste Profile Wprksheet for this ►+F:t!r <br /> the Facility Generator Waste Profile Workshe t and alsoThis document serves as a written lalsahe annualtion that hwrittenfverlreatioam N for descriplions and constituents found above are unchanged per <br /> ry na of perjury that the foregoing is true and correct. generator waste stream profile worksheet of these waste <br /> streams.I declare under the pe riy Pe I ry g <br /> Customer Print Name: '1 v i -ir.ir <br /> Customer Signature: - <br /> Date: l) <br /> Driver/Serviced By: - <br /> Date- I 7. <br />