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�M <br />C <br />O <br />F <br />rad <br />eanTech <br />Environmental Inc. <br />2581 S. Sunland Ave. • Fresno, CA 93725 <br />Phone: 800-531-9683 <br />WARTF RFCYCLING RECEIPT <br />Name: t , r All .Y_t tr€; ? P"4. is Customer Purchase Order # <br />Address: 01' 9 Vii:, "`" $fs �° Service Technician <br />City, State, Zip: <br />EPA ID #: CAIL.00036044-3 <br />#: ;s0li-.t� e:t :x012111 <br />Phone - � <br />L.• .. <br />Federal Manifest #: <br />QUANTITY <br />UNITS <br />U.S. DOT DESCRIPTION <br />CHARGE <br />GAL. <br />USED OIL — NON RCRA HAZARDOUS WASTE, LIQUID <br />CA WASTE CODE 221 <br />GAL. <br />USED ANTI -FREEZE — NON RCRA HAZARDOUS WASTE, LIQUID <br />CA WASTE CODE 134 <br />CA 93725 Fresno, <br />GAL. <br />OILY WATER FROM USED PARTS WASH SOLUTION — <br />NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 <br />EPA ID #: CAL000368136 <br />DRUM(S) <br />DRAINED USED OIL AND GAS FILTERS <br />Z <br />TOTAL <br />The above used oil is % Lubricating oil % Industrial oil <br />ACCOUNT STATUS: () C.O.D. () OPEN ACCOUNT If open Account - payment is due net 30 days or a finance charge of 1.5% <br />per month will apply. <br />GENERATOR'S NOTIFICATION AND CERTIFICATION; Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling facili- <br />ty that is lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act. I hereby declare that the contents of this consign- <br />ment are fully and accurately described above by fate proper shipping name and are classified, packaged, marked, and labeled and are in all respects in proper condition <br />for transport by highway according to applicable national regulations. All relevant information regarding known or suspected hazards associated with this waste has been <br />disclosed. The customer agrees to pay reasonable cost and attorney fees incurred in the collection of this obligation. Venue for purposes of this obligation shall be in <br />Los Angeles County. I declare.under perjury that the foregoing is true and correct. I hereby declare that the contents of this consignment are fully and accurately described <br />above by the proper shipping name, and are classified, packaged, marked, and labeled/placard, and are in all respects in proper condition for transport according to appli- <br />cable and national governmental regulations. If export shipment and I am the primary Exporter, I certify that the contents of this consignment conform to terms of the <br />attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I <br />am a small quantity generator) is true. I hereby certify that all information in this and all attached documents contain true and accurate descriptions of the waste. All rel- <br />evant information regarding known or sugpected• hazards associated with the waste has been disclosed. I also acknowledge that I have read and agree to the terms on <br />this form, both front and back. Signer guara7tt6es the payment CleanTech invoices in accordance with the standard terms of Net 30. If a purchase order is not issued, <br />the employee authorizing the work to be performed guarantees that any invoices presented will be paid promptly. Prompt payment is defined as payment in accordance <br />with CleanTech standard terms of 30 days. Invoice payment is not contingent upon payment by a third party. Interest on past due accounts will be charged at the rate of <br />1.+71hereberfify <br />paid. WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON-CONFORMIN WILL BE SUBJECT TO ADDITIONAL CHARGES. <br />71 oe-­ <br />NT FULL NAM I NATURE DATE <br />at I have read and have the authority to bind the above listed genera r to the terms on the reverse side of this form. <br />State Law requires that you keep this Receipt/Bill of Lading on file for no less than (3) years. <br />oc <br />CleanTech Environmental Inc. <br />2581 S. Sunland Ave.IM <br />a <br />CA 93725 Fresno, <br />TYPE OR PRINT FULL NAME <br />U) <br />EPA ID #: CAL000368136 <br />Z <br />cc <br />Truck, Unit ID No. <br />SIGNATURE <br />DATE <br />The checked box is the designated recycling facility <br />w z <br />0 K -Pure Waterworks ❑ AJS Filter Processing <br />❑ Crosby & Overton <br />0leolia ES <br />❑ Cleantech Environmental <br />Rd. <br />~ J — <br />J <br />8910 Rochester Ave. P.O. Box 90486 <br />1610 W. 17th Street <br />Technical Solutions LLC <br />5820 Martin <br />>_ <br />Rancho Cucamonga, 15131 E. Clark Ave. <br />Long Beach, CA 90813 <br />1704 W. 1st Street <br />Irwindale, CA 91706 <br />w <br />CA 91730 Industry, CA 91715 <br />EPA # CAD028409019 <br />Azusa, CA 91702 <br />EPA # CAL000330453 <br />Icc <br />I`i. <br />IL Ix <br />Ph # 909/476-9492 EPA # CAL000097432 <br />Ph # 562/432-5445 <br />EPA # CAD008302903 <br />Ph # 626/812-7200 <br />Ph # 626/333-5617 <br />Ph # 626/334-5117 <br />