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C1eanTech SERVICE WORK ORDER Environmental Inc. 2581 S. Sunland Ave. • Fresno, CA 93725 Phone: 800-531-9683 WASTE RECYCLING RECEIPT Name: Customer Purchase Order # Address: Service Technician City, State, Zip: Phone #: EPA ID #: Federal Manifest #: QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE GAL. USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 221 GAL. USED ANTI-FREEZE— NON RCRA HAZARDOUS WASTE, LIQUID oC CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION — cc cc GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 W Z DRUM(S) DRAINED USED OIL AND GAS FILTERS W 0 — M TOTAL w H JThe above used oil is _ --%Lubricating oil %Industrial oil CL 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- W 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 classifiedpackaged,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 and hazards associated with this waste has been 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. It 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 he 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 1.50/c per month until paid.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON-CONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. TYPE OR PRINT FULL NAME 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. W Clean Tech Environmental Inc. 2581 S.Sunland Ave. cc p Fresno, CA 93725 � EPA ID #:CAL000368136 TYPE OR PRINT FULL NAME Z Q Truck, Unit ID No. SIGNATURE DATE The checked box is the designated recycling facility W z Y Roadrunner Glycol, Inc. Ll Southwest Processors Li Heritage Environmental Ll Cleantech Environmental U t 4636 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 5820 Martin Rd. V Las Vegas, NV 89115 Vernon, CA 90058 284 East Storey Road Irwindale, CA 91706 U.1 w uQ. EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 CL oC Ph#702/379-7179 Ph#800/900-3366 EPA#AZD081705402 PH#626/812-7200 Ph#520/723-4167