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CleanTech SERVIC-E WORK <br /> KI Tr7 q _ En viFOnmen ttal Inc. <br /> i � �r�E � 2'581 S. Sunlarld Ave. a Fresno. CA 93725 .1951-126 <br /> =�`--- Phone: 8D - <br /> D 531-5683 <br /> WASTE RECYCLING RECEIPT <br /> fVame: z, } <br /> } CustOrner Purchase Order# <br /> Stale, Zfp'Address: <br /> Cit)1 ■ <br /> Sales Representative <br /> Ic e � fJ <br /> EPA ID#: + r Phone #: <br /> —� Federal Manifest <br /> QUANTITY UNITS U.S. DOT DESCRIPTION <br /> GAL. USED OIL–NON RCFIA HAZARDOUS WASTE,LIQUID CHARGE <br /> CA WASTE CODE 221 <br /> GAL, USED ANTI-FREEZE–NON RCRA HAZARDOUS WASTE, LIOUID <br /> CA WASTE CODE 134 <br /> D OILY WATER FROM USE[)PARTS WASH SOLUTION– <br /> cc <br /> GAL, NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CQpE 134 <br /> Lu <br /> DRUM(S) DRAINED USED OIL AND GAS FILTERS <br /> 0 <br /> co <br /> ❑ TOTAL. <br /> F. The above used afl is a <br /> ACCOUNT STATUS:~~ Lubricating oil irrdusfrfa!of! <br /> per march will apply. <br /> { C O'D { fJRN ACCOUNT If open Account-payment Is due net 30 days or a lfnancecharge of 1.596 <br /> d <br /> Gwfully o 18'S NrJTr accordance <br /> AND h 3 hazardotts Any used oil'hat'he Iransporler recaavea from:he genemlor will be transported to a CerUfaed usEd off recyaryng faclUty Iha!rs <br /> C] alxu l aperaaing to above by the <br /> Svph a haaardous waste tacaaities psrmfl issued pursuan!la rhe Fedgrel Aet,f hereby declare Ilial the cacen's d Ibis consignment are!idly and <br /> Lu accurately descrineai above by the proper�n7 shipprng name and are classsued,packaged,marked,and as f,I and ars in re that <br /> eche in <br /> M standards.All relavant Informatlen regarding known orsuspeeled ha2ards sseocfaled warn t <br /> fees incurred In the coda rge of Inas nblfgalipn.4zuue Ior purposes o'this ehhgatfop shat!be an Los Angeles County,f cenily that[ha tsasle nano Puy ora s a'Er Cost and attorney p e <br /> tits este face h2aa da5cluseo.The,cuslomer agrees to pay reasonaple cast and attomay <br /> III FR�6P27{a�{if I am a large quantity generator)or(h){if I am a small quaptfty ganeratol)is true.I also gel"acknI vledgo that f have read arra leres'o I a ion sf as psis fafm hoed b 40 <br /> oot <br /> and hack.Signer guarantees that <br /> payment of CfaanTaGh inaeices In accordance?Ath the standard terms of Net 3e days,if a Purchase order as net assued,ilia em <br /> work pariormad euarar secs Ihaf any artvaices Rresenfed wart be paid Prnnspgy Pram f <br /> WPIClnwa payment as not ED yo upon payment by a'hfrd party,interest an past due ace accounts wfment is�hencharged ai the rale of 5%part anth unlit paid in and jums a r MATER tAL3 <br /> WNICHAHf t1fSCUYEREo Te BE NON-CONFORM(lig WILL BE SUBJECT To ADDITIONAL CfaIARGES. C In <br /> 7OR PS FULL NAM � 7 <br /> 9IGNATUil �J bATE£�;I <br /> I hereby rator that a nape read gad have Ifre authority Io hind Iha strove)ya generator fo the terms found on both the front and back al this form,State Lau requires that both <br /> Iha Generator and Transporter keep this form on file for a minimum of 13y years,I hereby certify rhaf all Infarnlafron in ahls <br /> and a!I attached documents san'a [egL'and accurate <br /> descriptions of the waste Including That the waste is segregated and Is not com Inpled uilh olher waste streams.As the Generator,f acknowledga teal our sive EDA[D as active.The <br /> waste stream listed above compiles with the Nste <br /> and tvnstrtuen's found above are unchanged erthar arefflt Gerterafarcr,record for lhe Wastergnaled NON,Tfils P 011ie Warkshe01 a doc�rrerileervas as also aces as the annual w varil patioo that[flu Iva* <br /> va 11reaer{sy deserfplfon <br /> wcrkshee'of these waste sfreams.I declare ndar penalty f parfury fhat the foregaing is true andcorrecl, <br /> I�a cc M15talor Waste Profile <br /> LU <br /> u! CleanTech Environmental Inc.. <br /> 1— 2581 S.Sunland Ave. r <br /> o Fresno, CA 93725 �FypjC_ <br /> �OR�EPA ILD#:CALDOi7368136 DRIVE=R'S NAtMPWNT FULa_NAME <br /> d <br /> Truck, Unit 10 Nclo <br /> a C3 <br /> The checked box is the designated recycling facility SIGNATURE DA•E <br /> 1-- 0 Roadrunner Gtyro 1,lrtc. Q Southwest Processors <br /> U : 4636 Industrial Center Dr. 4120$andini Blvd. 0 Services Environmental ©Gieantech Enaironmerltal <br /> LU > Las Vegas,NV 89115 Services LLC 5820 Mann Rd, <br /> UJ W EPA#NVRGp0088421 Vernon,GA 9+7058 284 East Store Road <br /> EPA#C/909-346037 y Irwindale,CA 91706 <br /> Ph#702J379-7179 Ph#8001800-3366 COO AZ 85128 EPA#CAL000330453 <br /> FPA#A ZD081705402 Ph> 6261812.7200 <br /> Ph 15201723-4167 <br />