COMPLIANCE INFO_2021 - Laserfiche WebLink

Home Browse Search

SERVICE ' "VOR ORDEIZ M �UDEnvirionmental Inca 19 88 l 2 2581 S. Sunland Ave. a Fresno, CA 93725 Phone: 800-531-9683 Name; �C-e3 Customer Purchase Drder# Address: Salt=s Representative City, State, Zip: t'V t C Qj 5 3 Phone#: EPA 10#: CPH Dm4INTI Federal Manifest#: ] QUANTITY UNITS U.S.COT DESCRIPTION CHARGE GAL. USED OIL--NON RCRA HAZARDOUS WASTE, LIQUID i f� CA WASTE CODE t 221 GAL USED ANTI-FREEZE–NON RORA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 cc OILY WATER FROM USED PARTS WASH SOLUTION– GAL' NON-RCHA HAZARiDOUS WASTE,LIQU4). CA WASTE CODE 134 cc LU DRUMS) DRAINED USED OIL AND GAS FILTERS z to JVL TOTAL —� > The above used oil is %L>Jbricating oil %Industrial oil ILW ACCOUNT STATUS: ( y C.Q_D_ { )OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% per month will apply. O GENERATOR'S NOPFICATIDN AND CERTIFICATION:Any peed oil llml the trarisponer receives from the gereratorwlll be IransportV to a certified used oilrecycling facility That is 0 lawfully operallng In accordance with a hazardous waste facilities permit issued pursuant to the Federal Act,I hereby declare Ilial the contcnis of Ihis coasOment are fully and W accurately described above by the proper 0OTshipplrg name and are elassifiod,packaged,marked,and labeled and aFe in all aspects in proper condition Ior transport by 0 D.T. M standards.All relevant infwmalion regarding known of suspected hazards assoclated with Ihis waste has bean disclosed,The customer agrees to pay reasonable cosi and attorney fees incurred in the collection of this obligation.Venue for purposes e1 this obligation shall he in Los Angeles County.I codify Mai the waste minimization stafamenT Identifled in da CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a Small quantity generalor)is tree.l also acknowledge that 1 have read and agree to the Iarmsanrhls lorm both front and back,Slgmr guarantees the payment of ClaanTach involces in accordance with the sladard terms of Net 3l}days.iI a pvFdlase Order I$not issued,the emplayea authorizing lite work performed guaranlees Mot:any invoices presented told be paid prompiiy.Prompt payment is dannad as payment In accordance vdth CleanTech slandard lerms cl not 30 days_ Invoice payment Is nat contingent upon payment by a third party.interest on past due accounts WX be charged at the rate of 1.5°I per munlh until paid in ICII.WASTE MATERIALS WHICH ARE OISCDVEREO TO BE NONCONFORMING WILL BE SUBJECTTO AGGITIONAL CNAnGES. TYPE OR P T FULL NzAMEE SIGNATURE DATE I hereby codlty that I Nava read and have the authority to bind The above listed generator to The terms lound on 0014 the front and back of this form.Slate Lary requires that both the Generator and Transporter keep this farm an file for a minimum of(3)years.1 hereby certify that all inlormation 13 this and all attached documents confaln true and accurate desarlpllons of the waste Including that the waste is segreualed and is not comingled will;other waste streams.As the Generator.I acknowledge that our site EPA 043 is active.The waste stream listed above complies rvilh the Waste Pretite on record for Nie designated Faciltly.This dmomeal serves as written vetlticalw that the svasteslreamis)deseripllon and canatituenis found above are unchanged per The FactiltyGenerator Waste Frebie Worksheet and also acts as the anwml tvrilten veriflcallon lorlhe Generator Waste Profits Worksheet of Illase waste streams.i declare uhderpenalty o1 perjury Ihai Nis foregoing is true and correct. LU CleanTech Environmental Inc. � 2581 S.Slinland Ave. _ � .� ❑ Fresno, CA 93725 rip EPA ID #:CAL00036$136 DRIVER'S NAME•TYPE OR PRINT FULL NAME Truck, Unit ID No. SIGNATURE DATE O ❑ The checked box is the designated recycling facility ❑Roadrunner Giycol,Inc. 0 southwest Processors ❑Heritage Erivironmental ❑'Q�ch Environmental 4536 Industria!Center Dr. 4124 Dandini Blvd. Services LLC 5820 Martin Rd, } t] Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwiridale,CA 91706 W L EPA,#NVAGO0088427 EPA#CAL921646037 Coolidge.A7 85128 EPA#CALM0330453 CL GC Ph#7021379-7179 Ph 18001900-3366 EPA 0 AZD0S1705402 Ph#626/812.7200 Ph#52DR23-4167