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SERVICE WORK �-t7iean Tech T ORDER Environmental Inc. 91812 5820 Martin Road • Irwindale, CA 91706 Phone: 626-812-7200 WASTE RECYCLING RECEIPT Name: E'C ► 1 Z '', / G' Customer Purchase Order# Address: f`6.)1 Service Technician City, State, Zip: a '-v`; `'1 Phone #: I7 cam, 2 '-zi- EPA ID #:�� 4-^t��.-�� / I � � Q Federal Manifest#: 00 �� -' �� QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE GAL. USED OIL- NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 221 y GAL. USED ANTI-FREEZE- NON RCRA HAZARDOUS WASTE, LIQUID p� CA WASTE CODE 134 O OILY WATER FROM USED PARTS WASH SOLUTION— Q GAL. NON RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 ccw Z DRUM(S) DRAINED USED OIL AND GAS FILTERS LU C7 m TOTAL LU t- JThe above used oil is %Lubricating oil % Industrial oil IL ACCOUNT STATUS: ( )C.O.D. ( )OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% 0 per month will apply. U 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- lL 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- or 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 p for transport by highway according to applicable national regulations. All relevant information regarding known or suspected hazards associated with this waste has been H 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 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 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- 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 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 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- 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 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, 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 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 1.5%per month until paid.t ^ ' TYPE OR PRINT FULL NA16E SIGNATURE DATE 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. State Law requires that you keep this Receipt/Bill of Lading on file for no less than(3)years. cc CleanTech Environmental Inc. LU 5820 Martin Road DAVID ARSON p Irwindale, CA 91706 IL j'�`�TYPE OR RfNY F AME 0) EPA ID #: CAL000330453 - a Truck, Unit ID No. \ SIGNATURE DATE The checked box is the designated recycling facility LU z HC K-Pure Waterworks ❑AJS Filter Processing ❑ Crosby & Overton 2 Veolia ES ElEvergreen Oil Inc., Fresno U 8910 Rochester Ave. P.O. Box 90486 1610 W. 17th Street Technical Solutions LLC 4139 N.Valentine Ave. } URancho Cucamonga, 15131 E. Clark Ave. Long Beach,CA 90813 1704 W. 1st Street Fresno, CA 90722 CC w tai CA 91730 Industry, CA 91715 EPA#CAD028409019 Azusa, CA 91702 EPA#CAD982446882 a cc Ph#909/476-9492 EPA#CAL000097432 Ph#562/432-5445 EPA#CAD008302903 Ph#510/795-4400 Ph#626/333-5617 Ph#626/334-5117