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=-- C �ieanTech SERVICE WORK ORDER Environmental Inc. , 9 .1. 2 :1_ f 2581 S. Sunland Ave. • Fresno, CA 93725 Phone: 890-531-9683 WASTE RECYCLING RECEIPT - Name: Customer Purchase Order # Address: Sales Representative City, State, Zip: '+ Phone #: EPA ID* C4,,_'_ CJ Federal Manifest QUANTITY UNITS IJ,S.DDT DESCRIPTION CHARGE CAL USED OIL-NON RCRA HAZARDOUS WASTE, LIQUID 2 CA WASTE CODE 221 I� GAL. USED ANTI-FREEZE- NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 Q GAL. OILY WATER FROM USED PARTS WASH SOLUTION- NON-RCRA HAZARDOUS WASTE, LIOUID. CA WASTE CODE 134 LUDRUM(S) DRAINED USED OIL AND GAS FILTERS m TOTAL LUd The above used oil Is °fo Lubricating oil %Industrial all J ACCOUNT STATUS: ( }C.O.Q. { OPEN ACCOUNT if open Account-payment is due net 30 days or a finance charge of 1.S% ri per month will apply. 0 GENERATOR'S NOTIFICATION AND Cl RPFICATION:Any used all that the transporter receives from the generator will be transported 10 a certified used nil recycling facility that Is 0 laurfuily 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 LV accurately described above by the proper DOT shipping name and are classified,packaged,marked,and labeled and are In ail aspects in proper condition for transport by D.Q.T. M standards.All relevarl Information regardinp known or suspected hazards associated with this waste has been discloseA.The customer agrees to pay reasonable cost and attorney C fees incurred in the collection of this obligalion.Venue for purposes of this ohligallon shall be In Los Angeles County.h certify that the waste mininnUatioo statement Identified in 49 F., CFR 26227(a)(11 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 theterms on this form both front and hack.Signer guarantees Ire payment of CleanTech Invoices in accordance with the standard terms of Net 34 days.If a Purchase Order Isnot Issued,the employee authorizing the work perlormed guarantees that any invoices presented will he 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 he charged at the rate of 1.595 per month until pall in full,WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON-CONFORMING WILL BE SLIBJECTTO ADDITIONAL CHARGES. 7(,aG [ camVlkl TYPE PRINT FULL NAME 39TILJFIE DATE I hereby certify that I have read and have the a0iorily to bind the above listed generator to the terms found on both the front and back of this farm.State Law requires that bolh the Generator and Transparter keep this form on file for a minimum of(3)years. I hereby aerlify that all inlormation in this and all attached documents contain true and accurate descriptions of the waste Including that the waste is segregated and is not colningled with other waste streams.As the Generator.I acknowledge that out sde EPA ID#is active.The wasle stream listed above complies with the Waste Profile on record for the designated Fadiity.This document serves as written Verification that the waste siream(sl dascriplion and constituents found above are unchanged per the Faellhly Generator Waste Prolfle Worksheet and also acls as the annual written verificaflon foe Iha Generator Waste Profile worksheet ofthese waste streams.I declare under penally of periory that tha foregoing Is true and correct. er CleanTech Environmental Inc. UJI 2581 S. Sunland Ave. ❑ Fresno, CA 93725 - tal� EPA I p #: GAL04036$138 q IVER'S NA E-TYPE DRP INT FULL NAME z Truck, l�nit ID No. �c l r f" SIGNA URE �AVT The checked box is the designated recycling facility '2 Z ❑Roadrunner Glycol, Inc. ❑Southwest Processors ❑Heritage Environmental ❑Cleantech Environmental V 4636 Industrial Center Dr. 4120 Bandini Blvd, Services LLC 5820 Martin Rd. a 4Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irw]ndale,CA 91706 uJI LU LL EPA#NVR000088427 EPA#CAL921646037 Caclidge,AZ 85128 EPA#CAL000330453 a t]C Ph#7021379-7179 Pit#8001900-3366 EPA#AZD081795402 Ph#6261812-7200 Ph#520/723-4167