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Te Ch SERVICE WORK == (7 " ORDER RIVER Environmental Inc. 19 5 0 DD 2581 S.Sunland Ave. - Fresno, CA 93725 Phone;880-531-9683 [ _ WASTE RECYCLING RECEIPT Name: 3 � — Customer Purchase Order# Address: Sales Representative City, State,Zip: r�-� r�-t Phone #: EPA ID#r t�'_�� 1 Federal Manifest QUANTITY UNITS U.S.COT DESCRI PTION CHARGE 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 O GAL OILY WATER FROM USED PARTS WASH SOLUTION— NON-RCRA HAZARDOUS WASTE, LIQUIl3. CA WASTE CODE 134 w DRUM(S) DRAINED USED OIL AND GAS FILTERS a] TOTAL The above used pit i5 °,b Lubricating oil %Industrial nil ACCOUNT STATUS: ( )C.O,D. ( )OPEN ACCOUNT It open Account-payment Is due net 30 days or a finance charge of 1.5% CL per month will apply, pGENERATOR'S NOTIFICATION AND CERTIFICATION:Any used oil that the Iransporter i%vir es from The generator will be transported to a certlhed used orleMling lacility that Is 0 iaVAuhy operating io accordance wflh a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare that the contents of this cmignmeni are fully and Lid accurately described above by the props?DOT shipping name and are classified,packaged,marked.and labeled and are in all aspects In prcper condition ier transport by O.O.T. n7 standards_All relevant tatormation regarding known or suspected hazards associated with this waste has been disclosed_The sustomeragrees to pay reasowbte cost and attorney 0 lees Incurred in the collection of this obligation.Venue for purposes of this obligation shall he In Las Angeles County.I certify that the waste minimization stalemenl identified In 40 GFR 26227(a)(11 I am a Targe quantity generator)or(b)(111 am a smalJ quantity generator)is true.I also acknowledge that I have read and agree to the lerms m this Iorm both IronT and back.Signer guarantees the payment of CleanTech Invoices 15 accordance wilh the standard rerms of Net 30 days,11 a Purchase Order is not issued,the employae aulhorlZing the work performed guarantees that any invoices prasenled will be paid promptly.Prompt payment is dellned as payment in accordance with CleanTech standardlerms of nor 30 days, invoice payment is not contingent upon payment by a third parry.Interest an past due accounts will he charged at the rate at 1.5%per month until paid In hill.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON•CDNFOAMING WILL BE SIIBJECTTO ADDITIONAL.CHARGES, TYPE 4H PRINT FURL NAME %ONATUR DATE I hereby UNIly that I have read and have the authority to blvd The above listed geaeraloF to the terms found on butii Me front and back D1 this larm.Slalelaw requires that hnlh the Generator and Transportor steep this form on flit for a minJmum of{3)years.I hereby CEdity that all Information in this and all attached documents coaialn true and accurale desc?lpttons of the waste Indu ding that the waste is segregated and Is not Coming fed with Other waste streams.As the Generator,I acknoviledga that our site EPA In'is active.The wasle stream listed above complies with the Waste Proliia an record for the designated Facility.Thls document serves as krlllan vernicatlon that the tvas{1slmam(s)desolpllan and constituents lsund above ate unchanged por The Facility Generator Waste Prolile Worksheet and also aelsas the annual written variticallon ferthe Generator Waste Proille Warksheel at these waste screams.I declare under penalty of paqury that the foregoing Is true and correct. cc CleanTech Environmental Inc. LU h— 2581 S.Sunland Ave. 0 Fresno. CA 93725 f rL DFiEVER'S�NAM -TYPE OR PRINT FULL NAE EPA ID #.CAL000368136 °C Trtscic, Unit 1D Na. SIGNATURE CRTE � n 0 The checked box is the designated recycling facility ❑Roadrunner Glycol,Inc. Cl South WBst Processors ❑Heritage Environmental ❑Cleantech Environmental v :3 4636 Industrial Center Dr 4120 Bandini Blvd. Services LLC 5820 Marlin Rd, U Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91746 cc lu LU L EPA#NVIR00008 84 2 7 EPA#CAL921646037 Coolidge,AZ 85128 EPA i CAL000330453 CIL AC Ph#7021379-7179 Ph#800/900-3366 EPA#AZDOB 1705402 Ph#626/812-7200 1 Ph#520/723-4167