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�e a Tec SERVICE WORK ORDER Environmental Inc. " ' , 5820 Martin Road • Irwindale, CA 91706 Phone: 626-812-7200 WASTE RECYCLING RECEIPT Namtwp f : Customer Purchase Order# Address:: - Sales Representative,;�t City, State ,Pne : c5316 EPA ID#: r i4/.3_' Federal Manifest#: 0,56005-0 14 w nr;5 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 135 OILY WATER FROM USED PARTS WASH SOLUTION— Q GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 zDRUM(S) DRAINED USED OIL AND GAS FILTERS 7 7a7L r}g} c�j Lu M TOTAL fW-, The above used oil is %Lubricating oil %Industrial oil W ACCOUNT STATUS: ( )C.O.D. ( )OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1,5% IL 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 facility that is U lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare that the contents of this consignment are fully and W accurately described above by the proper DOT shipping name and are classified,packaged,marked,and labeled and are in all aspects in proper condition for transport by O.O.T. CID standards.All relevant information regarding known or suspected hazards associated vAth this waste has been disclosed.The=tomcr agree.to pay reasonable cost and attorney lees 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 26227(a)(if I ant 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 both 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 CleanTech standard terms of net 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 in full.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NONCONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. V) TYPE OR PRINT FULL NAME 'SIGNATUREC DATE 16 3 / I hereby certify that I have read and have the authority to bind 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 IO M 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 streams)description and constituents found above are unchanged per the Facility Generator Waste Profile Worksheet and also acts as the annual written verification for the Generator Waste Profile Worksheet of these waste streams.I declare under penalty of perjury that the foregoing is true and correct. W CleanTech Environmental Inc. 5820 Martin Road f - rr� f O Irwindale, CA 91706 - )" N.c� 5 IL DRI ER'S NAME-TYPE OR PRINT FULL NAME Z EPA ID#:CAL000330453 a Truck, Unit ID No. 32— SIGNATURE DATE The checked box is the designated recycling facility LU _z } ❑US Ecology Vernon ❑Lighting Resources ❑Patriot Waste Water ❑Heritage Enviornmental (5'f antech Enviornmental -- � 5375 S.Boyle Ave. 805 East Francis Street 314 W.Freedom Ave. Services LLC 5820 Martin Rd, >- v Vernon,CA 90058 Ontario,CA 91761 Orange,CA 92865 284 East Storey Rd, Irwindale,CA 91706 U1 w W< EPA#CAD097030993 EPA#CAR000156125 Ph#855/666-4299(24-Dispatch) Coolidge,AZ 85128 EPA#CAL000330453 CL pc Ph#800/266-7747 Ph#909/923-7252 Ph#714/921-4545 EPA#AZOO81705402 Ph#626/812-7200 Ph#520/723-4167