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.— C1e a n Te ch SERVICE=-- ORDER Environmental Inc. 1-94907 2581 S.Sunland Ave. • Fresno, CA 93725 Phone: 800-531-9683 WASTE RECYCLING RECEIPT Name: Customer Purchase Order# Address: _� (� Sales Representative City, State, Zip: ke.oDn ,r-1 Phone #: EPA ID #; n=Y-33�f 7 Federal Manifest QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE 211 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— QGAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 LUDRUM(S) DRAINED USED OIL AND GAS FILTERS LU Oe � f M TOTAL The above used oil is °IQ Lubricating oil %Industrial oil W ACCOUNT STATUS; i J C,O,D, f J OPEN ACCOUNT If open Account-payment Is due net 30 days or a finance charge of 1,5% tZ per month will apply. 0 0 GENERATOR'S NOTIFICATION AND CERTIFICATION:Any used vii that the transporter receives Irom the generator will be transported to a certified used all recycling facility that is 0 lawtulty operating In accordance:vrlth a hazardous waste facilities permit issued pursuant to the Federal Act. I hereby declare that the contents of Iflis consignment are fully and uJ accurately described above by the proper DOT shipping name and are classified,packaged,marked,and labeled and ars in all aspects In proper condHion for transport by D.O.T. M standards.All relevant information regarding known or suspected hazards associated with this waste has been disclosed.The customer agrees to pay reasonable cost and attorney 0 fees incurred In the collection oi this obligation.Venue for purposes of this abitgattan shall be in Los Angeles county.I certify that the waste minimizalmn stalement Identified in 40 r CFR 26227(a)(I1 I am a large quanilty generator)or(b)(if I am a small quantity generator)Is true.I also acknowledge that I have read and agree to the lermsan this form both front and back.Signer guarantees the payment of CleanTech Invoices In accordance with the standard larnss d Net 30 days.If a Purchase order Is not issued,the employee authorizing the work performed guarantees that any invoices presented will be paid promptly.Prompt payrt Dnt+s defined as payment In accordance wilh CleanTech standard terms of not 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 muath unill paid In ball WASTE MATERIALS WHICH ARE DISCOVERED TO BE NOF-CONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. t�Vivo �;W TYP QR PRINT FULL NAME SIGNATURE DATE 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 farm.State Law requires that both the Generator and Transporter keep this form an tile for a minimum of(3y years. I hereby certify that all infarmatlon in this and all attached documents contain true and aceurate descriptions of the wnsie including that the waste Is segregated and is not conigled with other waste streams.As the Generator,I acknowledge that our site EPA ID d Is active.The waste stream listed above complies wish the waste Profile on record for Mo designated Faclllly.This doeu nenl serves as written verification that the waste slrasm(s)description and conslltuenis found above are unchanged per the Facility Generator Waste Profile Warksheet and also sets as the annual written verification lsrthe Generator Waste Pfolile Worksheet of These waste streams.I declare under penalty of perjury that the foregoing is true and correct. Clean7ech Environmental Inc. 2581 S. Sunland Ave. f O Fresno, CA 93725 CSA ERA ID #:CALOQ(336813fi MVER�S NAME-TYPE OR PRINT FULL NAME Z cc Truck, Unit ID No, A SIGNATURE DATE t7 The checked box is the designated recycling facility LU Z >- ::j El Roadrunner Glycol, Inc. El Southwest Processors L1 Heritage Environmental L1Cleantech Environmental 4636 Industrial Center Dr. 4120 Sandini Blvd, Services LLC 5820 Martin Rd. Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 EPR#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 ix cc Ph#7021379-7179 Ph#8001900-3366 EPA#AZD081705402 Ph#6261812-7200 Ph#5201723-4167