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cmilift 0 SERVICE WORK cileanyelch - ORDER Eff-Or EMER En vrronmen tai Dice 19 51 7 L — 2581 S. Sunland Ave. Fresno, CA 93725 `{ `� Phone: 800-531-9683 WASTE RECYCLING RECEIPT Name: ! Customer Purchase Order# Address: IL Sales Representative City, State,Zip: l � _ I t Phone #: o j EPA ID #: 0j�D �i Federal Manifest#: QUANTITY UNITS U.S.DOT DESCRIPTION CHARGE= GAL, USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 221 GAL. USED ANTI-FREEZE—NDN RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 CC OILY WATER FROM USED PARTS WASH SOLUTION— 0 GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 WDRUMS) DRAINED USED OIL AND GAS FILTERS LU E— I TOTAL t LU The above used oil is 95 Lubricating oil 4 Industrial oil ACCOUNT STATJS: t j C.O.G. { )OPEN ACCOUNT If open Account.payment is due net,30 days or a finance charge of 1.5% ll per month will apply. 0 GENOATOR'S NOTIFICATION ANO CERTIFICATION:Any used ail that the Iransporier receives from the generator will be transported to a eertifiad used oll myallrig facility That Is L) tavrtully operating in accordance with a hazardous waste Innille6 permit issued pursuant le the Federal Act.I hereby declare that The contents of this onnslgmarit are lully and W accurardly described above by the proper COT shipping name and are Gasified,packaged,marked,and Iabcled and are in atl aspects in proper cmililionfer transport by O.O.T. M standards.All relevant Information regarding known or suspocled hazards associated with this waste has been disclosed.The customer agress to pay reaswoable cost and atlorney 0 Ices incurred in the colleclion of!itis obligation.Vanua Ior purposos of this obligairan shall be In Los Angeles County.I certify That the waste minlmizalton slalement idenlillm in 40 I— CFR 26227(a)(01 am a lPrge quantity generator)or(h)fiI I am a small quanlA9 generator}Is true.i also acknowledge that I have read and agree to the tarmsan this form both Ira at and back.Signer guarantaus the payment at CleaaTach invoices in accordanaa with Iha sUridard terms of Net 30 days.II a Purchase Order Is not issued.IN employee authorizing the wo6 perlarmed guarantees that any Invoices presented will he pard prornplty.Prompt payment is dabnad as payment in accordance wilh CfaanTech staadard terms of net 30 days. hrvfllCe payment is not conlingem upon payment by a third party.Interest on past due accounts will be charged at the rate of 1.5%per month unlit paid in leg,WASTE MATERIALS WHICH ARE DISCOVERED TO 8E NON-CONFORMING WILL,RE SUBJECT TO ADOITIORAL CHARGES. � ` 1. _ f TYPE OR PRINT FULL NAME e9TG 'DATE ��. DATE � I hereby cedlly that I have read and have the authority to bind the above IWad gemrat*6 the terms found on bath the front and back of this farm.State law requires Shat both the Generator and Transporter keep this form on file for a minimum of(3)years.I heresy cerllEy that all information In this and all attached documenls culain true and accurale descriptions of the waste including that the wasfa Is segregated and Is net comingled with other waste streams.As the Generator.I acknowledge that our she FPA in d is active.The waste stream listed above complies with the Waste Profile on record for the desigrialed Facility.This document serves as written verification that thswmteslream(s)deserlpliarl and constituents found ahnue are unchanged per the Facility Generator Waste Afoslle Worksheut and also actsas the annual Written verificotlan Ior 14111neratar Wasie Ffaffle Warksheal of Mesa wails.streams.I declare underpenalty of perjury that the foregoing is true and correct, CleanTech Environmental Inc. 2581 S.Sunland Ave. D Fresno, CA 93725 DRIVER"S NA4E-rTYPE 6R PRINT FULLNAME U) EPA ID#:CALOOD368136 — Q1-13 Truck, Unit ID No. r` S#GNpTUFiE PAV t The checked box is the de nated recycling facility LU Z H El Roadrunner Glycol,Inc. 0 Southwest Processors ❑Herltage Environmental ❑Clean! 0 Environmentai ❑ 4636 Industria]Center Dr. 4120 Bandint Blvd. Services LLC 5820 Marlin Rd. 2 } U Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 LU tu LL EPA#NVR0+74088427 EPA#CAL921646037 Coalldge,AZ 95129 EPA#CAL000330453 a Ir Ph#7a379-7178 Ph#8001900-3366 EPA#AZD081705402 Ph 0 6261812-7200 Ph#52W23-4157