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r7e <br /> ==C a Te <br /> SHVICEyyWORK <br /> h ~ ORDER <br /> DD En <br /> vino 17 if? e i7 tc-?l Inc. <br /> X1 S. Sunland Ave- FresnoCA 93725 !95114 <br /> 58 <br /> Phone: 800-531-9883 <br /> WASTE REQ UNG RECEIPT <br /> Name: _ <br /> Customer Purchase order# <br /> Address: Salt=s Representative <br /> City, State,Zip: y L0rti _ t Phone #: <br /> EPA ID 4: ��– �� �+.rt <br /> Z � Federal Manifest <br /> QUANTITY UNITS U.S.DDT DESCRIPTION <br /> r GAL. USED OiL.–NON HAZARDOUS WASTE,LIQUID CHARGE <br /> CA WASTE CODE 221 <br /> GAL USED ANTI-FREEZE–NON RCRA HAZARDOUS WASTE,LIQUID <br /> Ir CA WASTE CODE 134 <br /> p GAL. OILY WATER FROM USED PARTS WASE!SOLUTION– <br /> NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 <br /> m <br /> LU DRUM(S) DRAINED USED OIL AND GAS FILTERS <br /> z <br /> lu <br /> m ' <br /> n TOTALLU <br /> _r <br /> The above used ail Is <br /> Lubricating oil %Industrial ail r <br /> LU ACCOUNT STATUS: ( )C.D.D. <br /> { j OPEN ACCOUNT If Apert Account-payment is due net 30 days or a finance charge of 1.s% <br /> !Z per month will apply. <br /> O GENEFRGOR'S NOTIFICATION AND CERTIFICAMA!Any aced oil that the trafrsporter receives from the ganeralar will be Iransported to a redifled used olf rayuing facility Iha[Is <br /> 0 lawlnlly operaling In accordance with a hazardpus waste fa'011les perm[[Issued pursuant io the federal Ao.J hereby declare Thal the Contents of ibis censO snt ars fully and <br /> Ul aecurately described above by the proper DOTshlpping name and are classified,packaged,marked,and labeled and are in all aspects in proper eohdilioe Iwiransparl by t7.p,t <br /> 03 siandarft All relevant hilormatfon regarding knave or suspeciett hazards assacialed wilh this waste has beer{disclosed.The customer agrees to pay reasonable cosi and attorney <br /> fees Incurred in the coileclien of this abligallvn,Venue for purposes of this ahitoattan Shall be in Los Angeles County.I ceniry that the Wasle minimlzaUonsidrmen!dentifled In 4O <br /> CFR 28227(a){it I am a large quanlity generator}or ib){if t am a small quanilty generator)is true,t alga ackno%viedge chat i have read and agree t r the terms a this form both beef <br /> and baerf performed <br /> guarantees the payment ci CIL anTech irvaces fn accordance with the standard terms or Net 30 days,if a Purchase Order is not issued.Iheem0_.yec authorizing the <br /> work parforrr ed guarantees that any invoices presented will be paid prompily.Prompt payment f;defined as payment in accordance wilh CieanTech standardrerms of ael 30 days. <br /> Invoice payment is not contingent upon payment by a third Party,lnterest on past due accounts vrrlt he cha <br /> WHICH ARE 1115COVERED TO BE NON-CONFORMING WiLL 9E SIIRJECTTO ADDITIONAL CHMIGES,/,m'u <br /> rged al the rate of 1,59 per month until paid lnlull WASTE MATERfAtS <br /> ��R PRI FU�L NAME y <br /> FATE <br /> t hereby c lOF a that t have read and have oho op file to bifid the above listed ganaratvr to the terms foga on path the trout and back of this farm.Slate lar{requires that bolh <br /> the Generator and Transporter keep this form on}its for a minlrnum of lay years.I hereby cerllfy lhetAlfinto malion In this and all attached documents conialn irue and accurate <br /> descrfpttons of the waste Including that the waste Is segregated and is not cdminaled with other waste Scream,As the Generator,t acknowledge that our seta:PA IMs active.The <br /> waste scream Jisled above complies wilh the Waste Profile on record forthe designated Facility.This document serves as written verification that the wasle slrelmis)doscriplien <br /> and consitluants iDuatd above are unchanged psr the Favrav Ganeralor wasta NOON worksheel and also acts as the annual wrflten veriveation forthe Genentor Waste Profile <br /> Wurksheel or these waste streams,i declare underpeoafly of perjury that(No foregoing is true and correct_ <br /> ¢ CieanTech Environmental Inc. <br /> LU <br /> cc <br /> 2581 S.Sunland Ave. <br /> 0 Fresno, CA 93725 /41 <br /> f <br /> 2 EPA ID #:CAL000368136 DRIVER'S NAM9-TYPE OR PRINT FULL NAME <br /> 4 <br /> Truck, Unit ID No. •' �j — �} �5 <br /> SIGNAl`URE -bATFy <br /> Q a The checked box is the designated recycling Facility <br /> lu <br /> z ❑Roadrunner Glycol,Inc, ❑Southwest Processors ❑Heritage Environmental ❑Cleantech Environmental <br /> [U :3 4636 Industrial Center Or. 4120 Bandini Blvd, Services LLC <br /> U Las Vegas,NV 89115 VerlTatl,CA 90058 5820 Martin Ad. <br /> W Lu 4 EPA#NUR000088427 284 East StDrey Road Irwindale,CA91706 <br /> CL Ph#7021379-7179 EPA#CA900-3366 Coolidge,AZ 85128 EPA#CALOW330453 <br /> Ph 80D1900 3366 EPA it AZb081705402 Pit#626/812-7200 <br /> Ph 4 5201723-4167 <br />