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C( fea" TeCh = SERVICE WORD ORDER Environmental Ince 198173 2581 5.Sunland Ave, e Fresno, CA 93725 Phone: 800-531-9683 WASTE RECYCLING RECEPT Name: °� cv-=� _ Customer Purchase Order# Address* Sales Representative me ijai~ City, State, Zip: Ed.-am. LA 25add- Phone #., � _ - 4�,.��=�_rr� EPA IQ#:�,� Federal Manifest#: e) felliy QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE GAL. USED OIL-NON RCRA HAZARDOUS WASTE,LIQUID �,`�CA WASTE CODE 221 4� CAL. USED ANTI-FREEZE-NODI RGRA HAZARDOUS WASTE,LIQUID CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION- CRL. NON-RCRA HAZARDOUS WASTE,LIQUID. CA WASTE CODE 134 DRUM(S) DRAINED USED OIL AND GAS FILTERS Lu _ a TOTAL W Tile above used ail is %Lubricating all %Industrial oil J ACCOUNT STATUS: j G,O.f]. { j OPEN ACCOUNT N open Account-payment Is due net 30 days or a finance charge of 1.59; rL per month will apply. n d GENERAT-OR'S NOTIFICATION AND GERTWICANGN;Arty used oil that the transporter iecerves Irom the generator will be transported to a certifled used oilmyeling facility that Is C) lawfully operating in=ardanca Willi a hazardous waste facilities permIt Issued pursuant to the Federal Act.I haieby daclarn that the canlents of this ccnsignmem are fully and LLE accurately described above by the proper DOT shipping name and are elassiffed,packaged,marked,and laboted and are In all aspects in proper Gnnditfonfw transport by R.O.T. fl] standards.Ali relevant Intormaifoo regardfng known orsuspecled hazards assoclatsclwM INis waste has been disclosed.The customer agrees to pay reasornble cosi and atlemey Q lees Inc urred in the=116otion of this obligalfun.Venue for purposes of this obllgatfon shall be In Los Angeles County.I cerllry thal the waste minimization swinem fdentiflad in 4Q r CFR 26227(a)i11 I am a large obantify ganerafar)or{h)(TI 1 am a small gaartiity gerreralw)is lrue.I also acl nowtedge that I have read and agree to the lerma on Ilii$form both front and back signer guarantoefi'the payment of CleanTech invoices in accordance with the standard terms of Net 39 days.If a Purchase Order is out Issued.the employee authorizing the work performed guarantees that any invoices presented will be paid promptly.Prompi payment N defined as payment In accordance with CleanTach standard terms of net 30 days. Invoke payment is not conlirtgeal upon payment by a third pasty.Interest on past due accounts will be charged al the rate of 1.5%per month untll paid in fuh,WASTE MATERIALS WRICN ARE DISCOVERED TO RE NON-CONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. TYPE OR PRINT FULL NAME SIGNAT-0 iE RATE I hereby eerlity thal I have read and have the ailthorily to bind Wabove Ilsind oenerator to the terms found on both the front and hack of this farm.Stale Law requires that bollr the Generator and Tianspo der keep this form on file lar a minimum of(3)years.I hereby cerlffy that all informalion In this and all attached documents conWin Iruc and auciirdle descriptions of the vraste including that The waste is segregated and is not comlagied with other waste streams.As the G aneolor,I acknowledge that our aIle EPA ID 8 is active.The Wasle stream listed ahovd compiles with the Waste Profile an record for the designated Facility.This dorument serves as wrillen verification oral the waslesiteam(s)desarlpflon and sansllluernfs found above are unehileged per the FacfHly GeneralorWaste Profile Worksheet and also aels as the annual wrdten verification Fume ProlRe Worksheet of these waste streams.I declare under penalty of penury that 1145 foregoing is Iruc and correct. LU CleanTech Environmental Inc. 2581 S.5unland Ave. 4 _ O Fresno, CA 93725 (a. EPA ID#: CALC1t7D368136 DRIVER'S NAME-TYPE OR PRINT FULL NAME Truck, Unit ID No. SIGNATURE DATE The checked box is the designated recycling fapifity ❑Raadrurinsr Glycol,Inc. ❑Southwest Processors ❑Heritage EnvironmEnfai EX4Rte ech UvlronmenW 0 4636 Industrial Center Dr 4120 Bandini Blvd, Services LLC 5820 Martin Rd, > Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 EPA#NVRQ06088427 EPA#CAL921645037 Coolidge,AZ 85128 EPA#CAL000330453 a tx Ph#7021379-7179 Ph#8001900-3366 EPA#AZD081705402 Ph#6261912-7200 Ph#520/723-4167