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l l�ech SERVICE WORK CeanORDER f1 vi ro men to , inc. 2581 S. Sunland Ave. a Fresno, CA 93725 Phone: 800-531-9683 WASM RECYCU� RECEIP7 Name: Customer Purchase Order # Address: Sales Representative 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 CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION -- GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 T. DRUM(S) DRAINED USED OIL AND GAS FILTERS LU I T07A L I= The above used oil is % Lubricating oil % Industrial oil � ACCOUNT STATUS: } G.D.D. } OPEN ACCOUNT if open Account- payment is due net 30 days or a finance charge of 1.5% per month +mill apply. 0 GENERATOR'S NOTIFICATION AND CERTIFICATION:Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling facility that-is. 0 lawfully operating in accordance with a hazardous waste facilitles permit issued pursuant to the Federal Act. I hereby declare that the contents of this consignment are fully and LU accurately described above by the proper DOT shipping name and are classified, packaged, marked, and labeled and are in all aspects it proper condition for transport by 0.0_T. co standards.All relevant information regarding known or suspected 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 certify that the waste minimization statement identified in 40 CFR 2.6227(a)(if I am a large quantity generator)or(b) (if I am a small quantity generator) is true_ I also acknowledge that I have read and agree to the terms on this form bath front and back.Signer guarantees the payment of CleanTech invoices in accordance with the standard terms of Net 30 days. If a Purchase Order is not Issued,the employee authorizing the work performed guarantees that any invoices presented will be paid promptly. Prompt payment is defined as payment in accordance with Clean7ech standard terms of net 30 days. Invoice payment is not cQntfngent upon payment by a third party. Interest or past due accounts will be charged at the rate of 1.5% per month until paid in full.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON-CONFORMING WILL Bt SUBJECT TO ADDITIONAL CHARGES. TYPE OR PRINT FULL NAME SIGNATURE DATE I hereby certify that I have read and have the authority to hind the above listed generator to the terms found on both the front and back of this form. State Law requires that both the Generator and Transporter keep this form on file for a minimum of (3)years. I hereby certify that all information in this and all attached documents contain true and accurate descriptions of the waste including that the waste is segregated and is not comingled with other waste streams.As the Generator, I acknowledge that our site EPA ID#is active.The waste stream listed above complies with the Waste Profile on record for the designated Facility.This document serves as written verification that the waste stream(s) description and constituents found ahave are unchanged per the Facility Generator Waste Profile Warksheet and also acts as the annual written verification far the Generator Waste Prefile Worksheet of these waste streams. I declare under penalty of perjury that the foregoing is true and correct. CleanTech Environmental Inc. LU 2581 S. Sunland Ave. Fresno, CA 93725 DRIVERS NAME -TYPE OR PRINT FULL !NAME en EPA I D #: CAL000368136 Truck, Unit ID No. SIGNATURE. DATE The checked box is the designated recycling facility C3 0 ❑ Roadrunner Glycol, Inc. ❑Southwest Processors ❑Herita e Environmental ❑.Cleantech Environmental 9 4636 Industrial Centel' Or. 4120 Bandini Blvd. Services LLC 5820 Martin Rd. > 0 Las Vegas, NV 891.15 Vernon, CA 90058 284 East Storey Road Irwindale, CA 91706 0 EPA# NVR000088427 EPA# CAL921646037 Coolidge, AZ 85128 EPA#CAL000330453 LU Uj Ph #7021379-7179 Pkv# 8001900-3366 EPA#AZD081705402 Ph#6261812-7200 Ph #5201723-4167