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ORDER <br /> Cf e a <br /> n 7re SERVICE WORK <br /> Environmental incq 195599 <br /> 2581 S. Sunland Ave. a Fresno. CA 93725 <br /> Phone: 800-531-9683 <br /> WASTE RECYCLING RECEIPT <br /> Name; Customer Purchase Order <br /> Address, i :ar,,:ti R:,•` rue Safes Representative ivtlus <br /> City,State, Zip: <br /> EPA ID #: Phone#: <br /> ��P��_ <br /> Federal Manifest#: <br /> QUANTITY UNITS U.S.DOT DESCRIPTION <br /> GAL. USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID CHARGE <br /> CA 1+1fASTE COBE 221 <br /> GAL. USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID <br /> CA WASTE CODE 134 <br /> DGAL OILY WATER FROM USED PARTS WASH SOLUTION— <br /> NON-RCRA HAZARDOUS WASTE, LIQUID, CA WASTE CODE 134 <br /> X <br /> W DRUM(S) DRAINED USED OIL AND GAS FILTERS <br /> Z <br /> W <br /> 0 <br /> ❑ TOTAL <br /> w The ahnve used oil fs l <br /> W �%Lubricating oiler s�Industrial an <br /> ACCOUNT STATUS: ( )C.O.D. t }OPEN ACCOUNT If open Account-payment Is due net 3D days or a finance charge of 1.5% <br /> per month will apply, <br /> ❑ GENERATOR'S NOTIFICATION AND CERTIFICATION:Any used oil that the transporler receives from the generator will ba lranspoNed to a certified used elf 2oyrJiag iaCifity that is <br /> L1 fawfulfy operalfng In accordance with a hazardous waste 13c1111e6 permit issued pursuanl 18 the Federal Act 1 hereby declare that the Contents of Ibis wnsigament ars rutty and <br /> W aecuralely descrled above by Ilse proper OUT shrpptnp name and are classined,packaged,marked,and iahaled and are 11 all aspects in proper condiuonfor transport by D-o,I <br /> i3q sendards.Ail relevant Information regarding known or suspected hazards associated with this vras'e has bean disclosed.The customer agrees to pay reasonahs cost and attorney <br /> fees incurred In the collection of this ot%apon.Venue fpr purposes of this obligation shall be in Los Ange les County.f certify Ihat 1118 waste mtnfmlay lea statement identified is;y <br /> CFR 2&227(a)(If I am a large quantity genera(w)or(b){tf 40 <br /> t am a small uanti <br /> and hack.Signal guaraniees the Payment of C'eanTech in,nices In acaardaace will the standard larmssof Net 3a days.if o arkricWtOdge a lPurcha a Order is nor issued,l 1112103 read and agree to the tth the authoo ngh el <br /> work partormed guarantees that any invoices presented will be paid promptly.Prompt payment Is defined as paymeni In accordance with CleanTeoh standardterms of net 3p days. <br /> Invoice payment Is not ronhn9anl upon payment by a third party.Interest on past due accounts Wtf be charged al the rain of I.SYe per manlh until paid to ruR.WASTE net 30 ays- <br /> WHICH ARI:WSCGVEREO TO BE NOR-CONFORMING WILL BE SUDJECT TO A oDITIONAL CHARGES. <br /> TYPE Vri PRINT -ULL NRhhE y , <br /> SIGNATURE GATE <br /> I hereby raor athat'have read and have the authority l0 bintl the Shave listed generatorto the'arms found an balh the front and back of this form.State Law requires Ihat both <br /> the Generator and Transporter keep this farm an file for a minimum of(3)years.I hereby certify that all inlormahan tn'his and all atiached dacumenls contain lnu and accurate <br /> descriptions of the wase lncludlng the;the waste Is segregated and is not comji?glsd with other waste SUMS.As the Generator,I acknowledge that aur site€pA'D;Is actfu0,The <br /> waste stream listed above gomphes with the Waste Profile on record for the deslgnated Facility.This documeaf serves ae written mrWral'orr that the wasiti slreamia}destfigllan <br /> and eonslituen's found above are unchanged perthe Facllily Generator Waste Profile Worksheet and also acts asitia annual written verification farlhe GenaratorWasla Prnnla <br /> Warksheet of!hese WaSle Streams.I declare under penafty of per}ury that Iheforegb'nq f5true and correct. <br /> w <br /> C)eanTecil Environmental Inc, <br /> e� <br /> 2581 S_Sunland Ave, rl <br /> a. <br /> ❑ Fresno, CA 93725 <br /> EPA IC#: CAL000368136 DRfVER'S NAME-TYPE OR PRINT FULL NAME <br /> r <br /> � Truck, Unit ID Na. <br /> H- <br /> The checked box is the designated recycling facility SI RE DATE <br /> Llo <br /> 11 Roadrunner Glycal, Inc. ❑Southwest Processors ❑Heritage Enviranrnental © leantech En <br /> R 0 Z 4636 industrial Center Dr. 4120 Bandini Blvd. Services LLC Environmental <br /> R <br /> [3 has Vega;, NV 89115 VOMOR,CA 90058 284 East Stoney RoadIrwindale,C Rd. <br /> EPA#NVROOD088427 EPA#CAL921646037 CA 33 0fi <br /> CL I Ph#7021379-7179 Ph#BOG1900-3366 Coolidge'AZ 85128 EPR;P CALO0O3304S3 <br /> EPA#AZC]081705402 Ph#626A 12-7200 <br />