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.. ■ r 1 f► <br /> ;q �`' T Corporiate Office SE'RVICT WORK Mu <br /> Clean Tech�Cr� EPA ID#:CAL000330453 ORDER <br /> 5820 Martin Road • Irwindale, CA 91706 <br /> Phone: 1-800-531-9683 731166 <br /> www.cleantechenv.com <br /> SERVICE WORK ORDER <br /> SALES OFFICE: ❑ Fresno ❑ Irwindale ❑ Newark �P Sacramento ❑ San Diego <br /> k <br /> Name —17 , -. . f Customer Purchase Order# <br /> Address r.-'Si_ Sales Representative <br /> fill City State Zip t.. , Phone# _2 eq, <br /> EPA ID# Ck It!COD <br /> f Ala+ i <br /> 1k NON-RCRAIRCRA WASTE <br /> PART# DESCRIPTION MANIFEST# QTY. �LINIT PRICE SUB-TOTAL 41 <br /> O23523155 ABSORBENT MATERIALS (55 GAL.) <br /> J 92900DAC AEROSOL CANS (55 GAL.) <br /> Q 9290068E BRAKE FLUID(55 GAL.) <br /> 929 MBS BRAKE SHAVINGS (30-GAL.) <br /> in SNREGT EMPTY GAS TANKS (55 GAL.) y <br /> d 9DD0155 MIXED FUELS(GAS I DIESEL) (55 GAL.] 1 <br /> 9GRS00S OILY RAGS (55 GAL.) 1 <br /> (5 90SLO55 OILY SLUDGE (55 GAL.) <br /> 03 9FOQ355 PAINTED RELATED MATERIAL-LIQUID (55 GAL.) <br /> W Z221TO55 USED OIL FILTERS-METAL(NOT DRAINED) (55 GAL.) .� - r. - C. <br /> LLI <br /> 0 cc 23523055 USED OIL FILTERS-PAPER (55 GAL.) <br /> • _ Z ('f 22211155 USEDOILFILTERS-CRUSHED (55 GAL.) <br /> ill MRCRA MANIFEST FEE-RCRA WASTE <br /> W IN MNRCRA MANIFESTFEE-NON-RCRA WASTE 7r 0 a <br /> 2D Lu ke. <br /> 'Any Nan-Conforming Waste Subject to Additional Charges.UJ p <br /> EMPTY REPLACEMENT DRUMS �f <br /> H <br /> �j Z 55OTFF OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR USED OIL FILTERS No Charge 0.D0 <br /> _ a < 550TWB OPEN TOP(55 GAL.)DRUM-REPLACEMENT DRUM FOR WASTES <br /> 0 55CMB CLOSED TOP(55 GAL.)DRUM-REPLACEMENT OF WASTE <br /> U PARTS WASHER SERVICE <br /> Z 125WRS BRAKE WASHER RENTAL UNIT(112-GAL.)PORTABLE AIR OPERATED <br /> UJ 3OPWRS PARTS WASHER RENTAL UNIT(30-GAL.)DRUM MOUNT <br /> J SCS- SCS POWERSTAR PARTS WASHER SERVICE-CUSTOMER OWNED MACHINE <br /> U <br /> Z PSC- POWERSTAR SOLUTION <br /> D MANPW PARTS WASHER OIL WATER MANIFEST# f jt <br /> t` Q PRODUCTS <br /> (5 CCGRN55 CLEAN COOL-GREEN 50150 HEAVY DUTY 55 GAL. <br /> LLI CCGLDS5 CLEAN COOL GOLD RECYCLED 50 150 EXTENDED LIFE,UNIVERSAL 55 GAL. <br /> CL <br /> . 00 UAP100 UNIVERSAL ARSORaENT PADS- 1DD PADS PER BUNDLE <br /> IUAS030 UNIVERSAL SOCK- 30 PER PACK) i <br /> As the Generator,I acknowledge that our site EPA ID 0 is active and I needed CleanTech to sign as agent on the Generator Waste Profile Worksheet for this <br /> . wastestream(s).This document serves as a written verification that the waste stream(s)descriptions and constituents found above are unchanged per <br /> the Facility Generator Waste Profile Worksheet and also as the annual written verification for the generator waste stream profile worksheet of these waste <br /> streams.I declare under the penalty of perjury that the foregoing is true and correct. <br /> Customer Print Name: 4 __ - - <br /> Customer Signature; pate• E - tJ <br /> Driver!Serviced By: ) Date. " <br />