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CleanTech SERVICE =-- � WORK ORDER -,r:- (.'Environmental Inc. � --i581 S. Sunland Ave. • Fresno, CA 93725 Phone: 8170-531-96B3 WASTE RECYCLING RECEIPT Name: SQewj C0 Customer Purchase Order# Address: 6515 Po�� be Sates Representative City, State,Zip: goo CA X5366 _ Phone#: EPA ID #: CAL.CWOWFederal Manifest#: o QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE GAL. USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID f 10 CA WASTE CODE 221 1� GAL. USED ANTI-FREEZE-NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION- 4 GAL' NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 Lu DRUM(S) DRAINED USED OIL AND GAS FILTERS to G TOTAL - R Uj The above used vii is %Lubricating oil %Industrial oil ACCOUNT STATUS: ( }C.D.D. { }OPEN ACCOUNT if open Account-payment is due net 30 days or a finance charge of 1.5% d per month will apply. 0 GENEHATOR'S NOTIFICATION AND CERVFICATIGN:Any used oil that the transporter receives from the generator will be transported to a cerilfied used oil recycling faclfity that Is V lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare that the sonfems of this consignment are fully and LILI accurately described above by the proper DOT shipping name and are classified,packaged,marked,and labeled and are in all aspects in proper condition Ior transport by D.O.T. M standards.All relevant Information regarding known or suspected heaards associated with this waste has bean disclosed.The customer agrees to pay reasonable cost and attorney D fees Incurred in the collect€on of this obfigatlon.Venue for purposes of this obllgation shall be in Los Angeles County.I certify that the waste minirwaimi statement identified in 40 F— CFR 26221(a)(4 I am a large quantity generator)or(b)(If I am a small quantity generator)is true,f also acknowledge that 1 have read and agree to IN terms on this form both front and back.Signer guarantees the payment of CleaoTech invoices in aceurdance with the standard terms of Nes K days.If a Purchase order is not issued,lbeernployee auftfting the work performed guaranines that any invoicas 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 DfSCDVEREO TO BE NDN-CONFORMING WILL BE SUBJECT TO AnDMONAL CHARGES. X_ 001 � e`JC4rtx .1 - 13-zoZo TYPE OR PRINT FULL NAME SI01qATUF9 OATS I hereby cenlly that I have read and have the authority to hind the above listed genoralor la lbs terms round on both the ft and back of this farm,Stale Law requires that both the Generator and Transporter keep this form on file fora minimum of(3)years.I hereby certify that all informal-ion In Ibis and all ahached documents conlain true and accuraia descriptions of the waste including that the waste Is segregated and is not com{ngled with other waste streams.As the Generator,I acknowledge that our site EPA ID N is active.The waste stream listed above complies with the Waste Proline on record for the designated facility.This document serves as written verification that the wasteslream(s)description and constituents toured above are unchanged per the Facility Generator Waste Praflle,Worksheet and also acts as the annual written verification forllre Generator Waste Proilia Worksheet of these waste streams.I declare under penally of perjury that the foregoing is true and Correa, IM CleanTech Environmental Inc. 2581 S. Sunland Ave. GA 93725 i +11'a CL Fresno, DRIVER'S NAME-TYPE OR PRINT FULL NAME U) EPA ID#:CAL000368136 Z Truck, Unit ID No. SIGNATTJRE !]ATE The checked box is the designated recycling facility LU z ❑Roadrunner Glycol, Inc. I]Southwest Processors C Heritage Environmental eantach Environmental v M 4636 Industrial Center Dr. 4120 Bandini Blvd, Sernes LLC 5820 Martin Rd. >- a Las Vegas, NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 L EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 CL X Ph#7021379-7179 Ph#8001900-3366 EPA#AZDG81705402 Ph#6261812-7200 Plt#520/723-4167