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� C ==leanTech SERVICE WORK ORDER Environmental Inc, [,' 2581 S. SLtnland Ave. e Fresno, CA 93725 '} l 8 0 Phone: 800-531-9683 WASTE RECYCLING RECEIPT Name: - Customer Purchase Order# Address: 15 kq _ Sales Representative City, State, Zip: 175_ 4 Phone #: EPA ID #: 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 — QC'AL' NON-RCRA HAZARDOUS WASTE, L)QUID. CA WASTE CODE 134 LU DRUM(S) DRAINED USED OIL AND GAS FILTERS W M TOTAL G W Tne above used oil is °la Lubricating oil %Industrial oil F- - 1Li ACCOUNT STATUS- I l 0.0,D. { }OPEN ACCOUNT If open Account-payment la due net 36 days or a finance charge of f.S% ...J IL per month will apply. 0 GENERATOR'S NOTIFICATION AND CERTIFICATION:Any used oil that the transporter receives from the ganeratar will toe transported to a certified used uit recycling ta0lity that Is 0 lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act. I hereby declare that the contents of this constgnment 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. Cal standards.All relevant information regarding known or suspected hazards associated with this waste has been disclosed.The customer agrees to pay reasonable cost and allomey 0 fees Incurred in the collection of this obllgallon.Vanua for purposes of this obligation shall he In Los Angeles County.I certify that the waste minimization statement identified In 40 CFR 26247(a)(if I am a large quantity generator)or(b}(if I am a small quantity generator)is true.I also acknowledge the!I have read and agree to the terms on this tarn both front and back.Signer guarantees the payment of CleanTech Invoices In accordance with the standard terms of Net 30 days.It a Purchase Order is not issued,INtrnooyee 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 or net 30 days. Invoice payment is not confingent upon payment by a third party.Interest on past due accounts will be charoed at the rate of 1.5%per month until paid io full WASTE MATERIALS WHICH ARE DISCOVERED TO BE HON-CONFORATING WILL BE SUBJECT TO ADDITIONAL CHARGES. TYPE/OR PRINT FULL NAME IGNATLJRE DATE f 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 Genarator and Transporter keep[his form an ale for a minimum of(3)years.i hereby certify that all information in this and all attached dacQm0s ccflimi true and accurate descriptions nt the waste including that the waste is segregated and is not comingIzd voRb other waste streams.As the Generator,l acknowledge that our site EPA ID 9 is active.The waste stream listed above complies with the Waste Profile an record for the designated Far€city.This document serves as written verllicallon that the waste streams)description and cunsilluenls lound above are unchanged perlhe Faeilily Generator Waste Profile 1Worksheel and also aces as the annual written verlDeatfon Iorthe Generator Waste Profile Worksheet of these waste streams.I declare under penalty of perjury that the fotegoing is true and correct. W CleanTech Environmental Inc. 2581 S. Suniand Ave.cc 0 Fresno, CA 93725 cCIL EPA ID #:CAL000368136 DRIVER'S NAME-TYPE OR PRINT FULL NAME Q Y/ Truck, ' G Truck, Unit ID No. SIGNORE ATE The checked box is the designated recycling facility LU n ❑Roadruftner Glycal, Inc. I]Southwest Processors ❑Heritage Environmental ©Cleantech Environmental L) 4635 industrfai Center Dr, 4120 Bandinl Blvd. Services LLC 5820 Martin Rd. V Las Vegas, NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91705 Uj IliW EPA#NV R 0000884 27 EPA#CAL921646037 Coolidge,A2 85126 EPA#CAL000330453 CL cc Ph#70213379-7179 Ph#800/900-3366 EPA#AZD081705402 Ph if 626/812-7200 Ph#5 201723-41B7