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IM <br />O <br />Q <br />M <br />LU <br />Z <br />W <br />} <br />m <br />D <br />W <br />I— <br />w <br />J <br />a <br />2 <br />O <br />v <br />W <br />M <br />O <br />cc <br />W <br />H <br />CC <br />O <br />IL <br />Cl) <br />Z <br />MQ <br />1.1. <br />H <br />00 <br />W Z >- <br />J t <br />� } J <br />U <br />Ll <br />I!L M <br />qftQq f (0, (005WII <br />ISM SERVICE WORK <br />can i ech ORDER <br />Environmental Inc. 112529 <br />2581 S. Sunland Ave. • Fresno, CA 93725 <br />Phone: 800-531-9683 <br />WASTE RECYCLING RECEIPT <br />Address:'I"'""'„z �a? 30', <br />City, State, Zip: <br />EPA ID #: <br />Customer Purchase Order # <br />Service Technician <br />„ykra xAJ��, sQ{int$ <br />Phone #: <br />Federal Manifest #: <br />QUANTITY <br />UNITS <br />U.S. DOT DESCRIPTION <br />CHARGE <br />USED OIL — NON RCRA HAZARDOUS WASTE, LIQUID <br />GAL. <br />CA WASTE CODE 221 <br />USED ANTI -FREEZE — NON RCRA HAZARDOUS WASTE, LIQUID <br />' <br />GAL. <br />CA WASTE CODE 134 <br />OILY WATER FROM USED PARTS WASH SOLUTION — <br />GAL. <br />NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 <br />DRUM(S) <br />DRAINED USED OIL AND GAS FILTERS <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 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 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 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 guar0tees 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 />1.50% per m nth until paid. WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON -CONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. <br />J <br />...�,Pill, I- `r rte- _ -! - /.`•/ <br />TYPE,JR PRINT FULL NAM 91 NATURE DATE <br />I hereby ertify that 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 />CleanTech Environmental Inc. <br />2581 S. Sunland Ave. <br />Fresno, CA 93725 <br />EPA ID #: CAL000368136 <br />Truck, Unit ID No. <br />The checked box is the designated recycling facility <br />❑ K -Pure Waterworks <br />8910 Rochester Ave. <br />Rancho Cucamonga, <br />CA 91730 <br />Ph # 909/476-9492 <br />❑ AJS Filter Processing <br />P.O. Box 90486 <br />15131 E. Clark Ave. <br />Industry, CA 91715 <br />EPA # CAL000097432 <br />Ph # 626/333-5617 <br />❑ Crosby & Overton <br />1610 W. 17th Street <br />Long Beach, CA 90813 <br />EPA # CAD028409019 <br />Ph # 562/432-5445 <br />TYPE OR PRINT. FULL NAME <br />SIGNATURE <br />❑xVeolia ES <br />Technical Solutions LLC <br />1704 W. 1 st Street <br />Azusa, CA 91702 <br />EPA # CAD008302903 <br />Ph # 626/334-5117 <br />O _ IA <br />❑ Cleantech Environmental <br />5820 Martin Rd. <br />Irwindale, CA 91706 <br />EPA # CAL000330453 <br />Ph # 626/812-7200 <br />