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SERVICE WORK CleanTech ORDEP, Environmental Inc. 147408 2581 S. Sunland Ave. • .Fresno, CA 93725 Phone: 890-531-9683 ❑ (� WASTE RECYCLING RECEIPT �J Name: Oft, -4 e 0 k ftiLC&,` Customer Purchase Order# Address: ❑ nnitu Service Technician City, State, Zip: 1� q � �b Phone#: EPA ID#:_ CA � x, 3b�'+�O _ Federal Manifest#: 0!-10-7091 -� 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 4GAL OILY WATEI4 FROM USED PARTS WASH SOLUTION— NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 uJ n2J DRUMS) DRAINED USED OIL AND GAS FILTERS C� 7- m ❑ TOTAL UJ J The above used oil is %Lubricating ail %Industrial all �- ACCOUNT STATUS; C.O.D. [ y OPEN ACCOUNT if open Account-payment is due net 30 days or a finance charge of 1.5% D per month will apply. 0 GENERATOR'S NOTIFICATION AND CERTIFICATION: Any used oil that the transporter receives from the generator will be transported to a certified used all recycling facili- �J ty that Is lawfully operating in accordance with a hazardous waste facilities permit Issued pursuant to the Federal Acta I hereby declare that the contents of Cis 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 prop¢r condition O for transport by highway according to applicable national regulations. All relevant information regarding known or suspected hazards associated with this wasle has been I— disclosed. The customer agrees to pay reasonable cost and attorney fees Incurred in the collection of this obligation. Venue for purposes of this abligatimshall be In Las 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 ancuratek described above by the proper shipping name,and are classified,packaged,marked,and labeled/placard,and are in all respects in proper condition far transport accorag to appli- cable and national governmental regulations. If export shipment and I am the primary Exporter,l tort€fy that the contents of this consignment can form to Wms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement Identified In 40 CFR 262.27{a}(€f I am a large quantity generate¢or(h)(if I am a small quanilty generator)is true. 1 Itaroby certify that all Information In this and all attached documents contain true and accurate descriptlons 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 to terms on this form,both front and back. Signer guarantees the payment ClaanTech€nvolcas In accordance with the standard terms of Net 30. If a purchase ordar isnot issued, the employee authorizing the work to be performed guarantees that any invoices presented will he paid promptly. Prompt payment Is daflned as payment In accordance With CleanTech standard terms of 30 days. Invoice payment Is not contingent upon payment by a thlyd party. interest on past due accounts will be charged althe rate of 1.5%per month until paid. WASTE MATERIALS WHICH ARE DISCOVERED TO 0E N0N49enera W LL BE SuBJEUTTO ADDITIONAL CHARGE �tnlAd4'l 3 Z911 7 TYPE OR PRINT FULL�RME TURE DATE I hereby certify that I have read and have the authority to hind the above listthe terms on the reverse side of this form. State Law requires that you keep this Flece€pt113€1I of Lading on file for no less than(3)years. C: CleanTech Environmental Inc. H 2581 S.Sunland Ave. QFresno, CA 93725 Typ2PRIN U AME Z EPA ID* CAL000368136 A a Truck, Unit I❑ No. - SIGTUBE BATE The checked box is the designated recycling facility LU Z © Roadrunner Glycol,Inc. ❑Bango Oil LLC El Crosby&Overton El Fleritage Environmental Iearitech Envflonmental 1 v 4636 Industrial Center Dr. 22211 Bango Rd. 1610 W.17th Street Services LLC 5820 Martin Rd. [] Las Vegas,AIV 89115 Fallon, NV 89406 Long Beach,CA 90813 284 East Storey Road Irwindale,GA 91706 I= EPA#NVRODOOBB427 EPA#NVROODOOD655 EPA#CAD028409019 Coolidge,AZ 85128 EPA#CAL000330453 t3 X Ph#7021379-7179 Ph#7751867.5082 Ph#5621432-5445 EPA#AZD081705402 Ph#62012-7200 Ph#5201723-4167