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SERVICE WORK Clean Te th ORDER Environmental Inc. 149685 2581 S..Smdand Ave. - .Fresnp,.CA_ 9-, - 6. Phone`- 800-531-9683 WASTE RECYCLING REC l Name: I tlj_dkA�. Customer.Purchase Order# :4 Address: _ Service Technl ' City, State, Zip: Phone#: IL EPA ID#: ,9 t(QC _ Federal Manifest#: QUANTITY UNITS U.S.DOT DESCRIPTION .. CHARGE GAL. USED OIL=NON.RCRA HAZARDOUS WASTE, LIQUID' GA-WASTE CODE-221:-- LL GAL 'USED ANTIFREEZE--•NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134'-- OILY WATER FROM USED PARTS WASH SOLUTION �. GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE 06DE 134 WDRUM(S) DRAINED USED OIL AND GAS FILTERS TOTi41 � z1J The above used ail is 56 Lubricating'ail '` °,�Industrial'all ` IL ACCOUNT STATUS: ().0.0.13. [ }OPEN ACC,06 IT If open Account-payment is due net 3o days or a finance chardeaf 1.6% ❑ 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 certilled used nil rWling faclll- w ty that is lawfully operating in.accordance with a.hazardous waste facilities.permlt issued.pursuant to the F.ederal:Act. I herehy declare thatthe,contents-of ihlp consign- In meat are fully and accurately described above by the prapar shlpping name-and are.classiffed,packaged,.marked,and labeled.and are In all respects In proper.cpndition ❑ for transport by highway according to applicable national regulations. All relevant information regarding known or suspected Hazards associated with this Wsta has been disclosed. The customer agrees to pay reasonable cost and-attomey.fees incurred,tn the collection of thts obligation: Venue for purposes of'thts obligation shA be in Los Angeles County. I declare under perjury that the foregoing istrne and correct. 1 herehy declare that.the,nontents of this consignment are fully and accuraidyde-scribed above by the proper shipping name,and are classified,packaged,marked;aria Iabeledlplacard,and are in all rosprots in proper condition for transport according'to appli cable and national governmental regulations. lf-expo(t shipment and i afn_tlfe.:primary Exporter,I certify thattho contents of this consignment copfarm tetams of the attached EPA Acknowledgment of Consent. I certify that the waste minlmlzatlon statement Identified In 40.CFR 262.27(a)(it l am.a large.quantity-generator)or.[b](if I am`a small quantity generator)is true.`.I hereby'certlfy that all InformatioH Id this and all attached documents contain true and accurate-dawriptlons of the oasts;' I rel- event lnformation regarding known or suspected hazards associated with the,waste.has been-disclosed.,l also acknowledge.that 1.have read and agree.to the terms on this form,both front and hack. signer guarantees the.paymerlt GteanTnch irivoicos.in accordanc..e with-the standard terms of Net 30..If,a purchase order k not issued, the employee authorizing the work to be performed guarantees that any Irivolces presented'wfl1 be paid promptly. Prompt payment is defined as payment to accordance with GleanTech standard terms of 30:days.-Invoice payment is not contingent upon paymerit.b Interest on past due accounts will be charged at the rate of 1:5°lo per month until paid.WASTE MATERIALS WHICH ARE OESCOUEREpf70..BE NO N- AMIHG WI L BE SUBJECT TO Ao01TlUHAI CHARGES. . TYPE OR PRINT FULL NAME NATURE DATE hereby certify that I have read and have the authority to hind the above iiste generator to the terms an the reverse side of this form. State Law requires that you keep this ReceipiVElill of Lading on file for no less than(3)years. CC Clean Tech Environmental Inc. 2581 S.Sunland Ave. = j CA 93725 :, ! Q Fresno,. E OR PRINT AME EPA ID#:CALOQ0368136 I Z Truck, Unit ID IVa. SIGNATURE DATE The checked box is the designated recycling facility 1U z ❑ Roadrunner Glycoi,Inc. C] Southwest Processors ❑ Heritage Environmental 10)Cleantsch Eq'vironmental 4636 Industrial Center Dr. 4124 Bandini Blvd. Services LLC 5820 Martin Rd. rJ R Las Vegas,MV89115 Vernon,CA 90058 284 East Stoney Road Irwindale,CA 91706 EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL600330453 a Ph#7021379-7179 Ph#8001900-3366 EPA#AZD081705402 PH#626/812-7200 Ph#5201723-4167