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SERVICE WORK � CieanTech � ORDER Environmental Inc. 2581 S. Sunland Ave. • Fresno, CA 93725 187098 Phone: 800-531-9683 WASTE RECYCLING RECEIPT Name: I Customer Purchase Order 4 # Address: Ii� I � Sales Representative City, State, Zip: 914 0 4 �� Phone#: EPA 1D#: 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 4 UJI DRUM(S) DRAINED USED OIL AND GAS FILTERS 2 LIJ} Im TOTAL d W The above used oil is %Lubricating oil % Industrial oil � ACCOUNT STATUS: I C.O.O. ( }OPEN ACCOUNT if open Account-payment Is due net 30 days or a finance charge of 1.5% CIL per month will apply. 0 GENERATOR'S NOTIFICATION AND CERTIFICATION:Any used DII that the Iransponer receives from the generator will be transported to a certified used oil recycling facility that is V lawfully operating in accordance with a hazardous waste facillties permit issued pursuant to the Federal Act.I hereby declare that the contents of this consignment are Tully and W accurately described above by the proper DIST shipping name and are classified.packaged. marked,and labeled and are in all aspects In proper condilion for transport by O.O.T, On standards.All relevant information regarding known or suspected hazards assoclaled with this waste has been disclosed.The customer agrees to pay reasonable Cost and attorney 0 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 minimizatlon slalament idenlffied In 40 CFR 26227(a)(if I am a large quantity generator)or(b)(it I am a small quantity generalorE is true.I also acknowledge that I have read and agree to the terms on this term both front and back.Signer guarantees the payment of CleanTech frivolces In accordance With the slandard terms of Net 39 days.Ila Purchase Order Is not issued,iheemptoyee authorIzIng the work performed guarantees that any Invoices presented w111 be paid promptly.Prompt payment is deflned as payment In accardance with CleanTech standard terms of net 30 days. Involce payment is not contingent upon payment by a third party.Interest on past due accounts will he Charged at the rate of 1.51A per month until pald in full.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON•CONFOANING WILL BE SUBJECT TO ADDITIONAL CHARGES. I!� 1 � �z� T'1 E R PRINT FULL NAME SIGNATURE DA E 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.Slate Law requires that both the Genarator and Transporter keep this form on file for a minlmum of(3)years.I hereby certify that all information In this and all attached documents contain true and accurate descriptions of the veaste including that the waste Is segregated and is not comingled with other waste streams.As the Generator.I acknowledge that our site EPA In 0 is active.The waste stream listed above complies with tate Waste Profile on record for the designated Facility.This document serves as written verification that the waste sheam(s)description and constituents found above are anchanged per the Faciilty Generator Waste Prorile Worksheet and also acts as the annual written verilrcalton lorJhe Generator Waste Profile Worksheet of these waste streams.I declare under penalty of perjury that the loregoing Is true and correct Inc CleanTech Environmental Inc. 2581 S. Sunland Ave. 1/] f 0 Fresno, CA 93725 � �� W EPA ID #:CAl_D�74368136 DPIV I AME-TYPE OR PRINT FULL NAME NTruck, Unit ID No. SIGNATURE DATE The checked fox is the designated recycling facility LILI z } ❑Roadrunner Glycol, Inc. 0 Southwest Processors El Heritage E=nvironmental D CleanTech Environmental Zi t 4636 Industrial Center Dr. 4120 Bandlni Blvd. Services LLC 5820 Marlin Rd. Las Vegas, NV 89115 Vernon,CA 90058 284 Last Ste rev Road Irwindale,CA 91706 EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 � LL W Ph#702!379-7179 Ph#8001900-3366 EPA#AZD081705402 Ph#6261812-7200 Ph#5201723-4167