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O <br />a <br />Cr <br />W <br />Z <br />W <br />0 <br />IM <br />a <br />W <br />F- <br />W <br />J <br />C. <br />2 <br />O <br />v <br />W <br />rti <br />O <br />H <br />W <br />H- <br />O <br />CL <br />U) <br />Z <br />d <br />cc <br />H <br />=tleanTech0 <br />(Soy b&� AoV <br />SERVICE WORK <br />ORDER <br />Address: <br />City, State, Zip: <br />Service Technician <br />Phone #: <br />Federal Manifest #: <br />112212 <br />QUANTITY <br />UNITS <br />U.S. DOT DESCRIPTION <br />CHARGE <br />z >- <br />K Pure Waterworks <br />USED OIL — NON RCRA HAZARDOUS WASTE, LIQUID <br />&Overton <br />Veolia ES <br />GAL. <br />CA WASTE CODE 221 <br />8910 Rochester Ave. <br />P.O. Bo1610 <br />W. 17th Street <br />USED ANTI -FREEZE — NON RCRA HAZARDOUS WASTE, LIQUID <br />5820 Martin Rd. <br />U <br />GAL. <br />CA WASTE CODE 134 <br />Long Beach, CA 90813 <br />1704 W. 1st Street <br />Irwindale. CA 91706 <br />OILY WATER FROM USED PARTS WASH SOLUTION — <br />CA 91730 <br />Industrv, CA 91715 <br />GAL, <br />NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 <br />EPA # CAL000330453 <br />LU <br />LU X W <br />DRUM(S) <br />DRAINED USED OIL AND GAS FILTERS <br />Ph # 562/432-5445 <br />EPA # CAD008302903 <br />Ph # 626/812-7200 <br />Ph # 626/333-5617 <br />-7 <br />TOTAL <br />The above used oil is % Lubricating oil-- 1, Industrial oil <br />ACCOUNT STATUS: O 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 <br />acilrty that is lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act. 1 hereby declare that the contents of this consign- <br />ment are fully and accurately described above by the 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 largequantity generator) or (b) (it I <br />am a small quantity generator) is true. I herehy certify that all information in this and all attached documents contain true and accurate descriptions of the waste. All rel- <br />evant infonmation regarding known or suspected 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 guarantees 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 />i.5% per month until paid. WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON -CONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. <br />TYPE OR PRINT FULL NAME SIGNATURE DATE <br />I hereby certify that I have read and have the authority to bind the above listed generator 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 />CleanTech Environmental Inc. <br />2581 S. Sunland Ave. <br />Fresno, CA 93725 <br />EPA ID #: CAL000368136 <br />Truck, Unit ID No. <br />TYPE OR PRINT FULL NAME <br />SIGNATURE <br />DATE <br />The checked box is the designatWrelc'ui <br />z >- <br />K Pure Waterworks <br />AJS Filtrosby <br />&Overton <br />Veolia ES <br />Cleantech Environmental <br />V _j <br />8910 Rochester Ave. <br />P.O. Bo1610 <br />W. 17th Street <br />Technical Solutions LLC <br />5820 Martin Rd. <br />U <br />Rancho Cucamonga. <br />15131 <br />Long Beach, CA 90813 <br />1704 W. 1st Street <br />Irwindale. CA 91706 <br />CA 91730 <br />Industrv, CA 91715 <br />EPA # CAD028409019 <br />Azusa, CA 91702 <br />EPA # CAL000330453 <br />LU <br />LU X W <br />Ph # 909/476-9492 <br />EPA # CAL000097432 <br />Ph # 562/432-5445 <br />EPA # CAD008302903 <br />Ph # 626/812-7200 <br />Ph # 626/333-5617 <br />Ph # 6261334-5117 <br />