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Clean "Tech s VICE WORK ORDER Environmental Inc. 2581 S. Sunland Ave. - Fresno, CA 93725 Phone: 800-531-9683 WASTE RECYCLING RECEIPT Name: Customer Purchase Order# Address: S t 5 Sales Representative City, State, Zito: Phone #: EPA lD#: A4 Federal Manifest#: _03cpN33C5 WAS QUANTITY UNITS U.S.CGT 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 O GAL. OILY WATER FROM USED F=ARTS WASH SOLUTION— NON-RCRA HAZARDOUS WASTE,LIQUID. CA WASTE CODE 134 LUDRUM(S) DRAINED USED OIL AND GAS FILTERS w � an 0 TOTAL —7• Uj The above used oil is Io Lubricating oft % Industrial ail W ACCOUNT STATUS: { }0,0,0. 1 OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% CIL per month will apply. 0 GERERATDR'S NOTIFICATION AND CERTIFICATION:Any used oil that the transporter receives from the generator will be,transported to a eertffled used oil recycling facility that Is 0 lawfully aperatino 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 LU accurately descrihad above by the proper DOT shipping name and are classified.packaged,marked,and labeled and are in all aspects in proper condttlon for transport by 0.9 T rn standards.All relevant Information regarding known or suspected hazards associated wilh this waste has been disclosed.The customer agrees to pay reasonable cost and attorney 0 fees incurred in the collection of this obligation.Venue far purposes of this obligation shall be in Las Angeles Cnunty.I certify that the waste mir;imt2atinn statement identified to 40 r CFR 26227(a)(it 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 both front and hack.Signer guarantees the payment of GleanTech invoices in accordance with the standard terms of Net 30 days,if a Purchase Order is not Issued.Ma employee authorizing the work performed guarantees that any Invoices presented will be paid promptly.Prompt paymem Is defined as payment in accordance with CieanTeO standard terms of net 30 days. Invoice paymenl Is not confingent upon payment by a third party.Interest on past due accounts WIfI be charged a1 the rate of 1.5%per month until paid In full.WASTE MATER{ALS WHICH ARE OlscdvEHEd To BE NON-CONFORMING WILL BF SUBJECT TO ADDITIONAL CHARGES. TYPE OR INT(FULL NAME V SIGNATURE DATE I hereby certify that I have read and have the authority to hind the above listed generator to the terms found on bath the front and back WON form.5iate Law requires that both the Generator and Transporter keep this form on We for a minimum of(3)years.1 hereby certify lhat all information In this and all attached documents contain truce and accurate descriptions of the waste including that the waste is segregated and is not t:omingled with other waste streams.As the Generator.I acknowledge that oursite EPA ill d 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 thewasle stream(s)description and constituents found above are unchanged pay Ills Facility Generator waste Protlle Worksheet and xlso HIS as Iha annual written verlficattah fortha Generator Waste Profile Worksheet of these waste streams.I declare under penalty of perjury that the foregoing is true and CDrraCt, W CieanTech Environmental Inc. � 2581 S. Sunland Ave. 0 Fresno, CA 93725 1A/iII�aw� N EPA Id #: CALflC10358138 DRIVER'S NAME-TYPE OR PRINT FULL NAME a Fes, Truck, Unit IQ Na. _ _ �� �� ? _ SIGNATURE DATE The checked box is the designated recycling facility LU Z >- El Roadrunner Glycol, Inc. ❑Southwest Processors ❑Heritage Environmental leantech Environmental 0 :i 4636 Industrial Center Dr. 4120 Baftdini Blvd. Services LLC 5820 Martin Rd. > V Las Vegas, NV 89115 Vernon,CA 90458 284 East Storey Road Irwindale,CA 91706 W EPA#NVR 000088427 EPA#CAL921646037 Coolidge,Air 85128 EPA#CAL000330453 IL cc Ph#7021379-7179 Ph#8001900-3366 EPA#AZD081705402 Ph#6261812-7200 Ph#5201723-4167