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SERVICE WORK es%zx%n i le chORDER F7-3Environmental Dace 195 r- ;`,'l��' r}�� 2581 S. Sunland Ave. - Fresno, CA 93725 Phone, 840-531-9683 WASTE RECYCLING RECEIPT Name; ��1' �=�,[' Customer Purchase Order# Address: Sales Representative City, State,Zip: _) —7 0 Phone#: EPA ID#: ') [ f Federal Manifest QUANTITY UNITS U-S.DOT DESCRIPTION CHARGE GAL. USED OIL—NON AGRA HAZARDOUS WASTE, LIQUID � ! CA WASTE CODE 221 r GAL USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION— QGAL. NON-RCRA HAZARDOUS WASTE, LIQUID, CA WASTE CODE 134 DRUM(S) DRAINEC) USED OIL AND GAS FILTERS z 0 , {g ' DO TOTAL FThe above used❑!l Is %Lubricating oil %Industrial oil W ACCOUNT STATUS: { J C.0.0. { j OPEN ACCOUNT If open Account-payment Is due net 30 days or a finance charge of 1.5%a a per month will apply. 2 0 GFAtERATGR'S NOTIFICATION AND CERTIFICATION:Any used ell that the Iranspo-rfer recelvut from Ilse generator will he transported to a certined used oil wnliag facility that is U lawfully operating in accordance with a hanrdaus waste fadlltles permit issued pursuant to the Federal Acl,I hereby declare that The contenis oI IhisUMVnment are fully and W accurately desafbed above by the proper DOTshipping name and are classified,packaged,marked,and labeled and are In all aspacts in proper candilionfor transport by D.D.T. Lr1 standards.Ail relevant information regarding known of suspected Wards assadated with this waste has been dlsolosed.The customer agrees to pay reasonabfeeesi and attorney 0 fees Incurred in the collection of Ibis obligation,Venue lorpurposes of ibis obligation shall be In Las Angeles Counly.I certify Ihal the waste minlmizallonslalemenl idenillied In 40 111-- CFR 26227(a)(11 I am a Targe quantity generalor)or(b)(if I am a small qua nlity generalor)is true,f also acknowledge that i have read and agree to die terms an this form beth front and back_Stoner guarantees the payment of CleanTech invoices In accordarree with the standard terms of Net 30 days.If a Purchase Mar Is nol issued,the emplpyee authorizing Jhe work perlormed guarantees that any invo;Ces pfese*d wiB he paid promptly.Prompt payment is defined as payment In accordance with CkanTech standard terms of net 30 days. Invoice payment is not contingent upon paymeet by a third party.Inle rest on past due accounts will Ira charged at Ibe rate of 1.5%per month until paid la lull,WASTE INATERIALS WHICH ARE DISCOVERED TO BE NON-CONFORMING WILL BE SUBJECT TO ADDIrJONAL CHARGES. r� aqwr - ! PE 4R PRINT LL NAM rG TORE pA I heraby cetil[y th have read and have the authority to bine c above listed Generator to the(arms found on both the front and back of this form_State Lm redulres that both the Gancrator and Transporter keep lhis Iolm on ffle fora minlmum of(3)years.i hereby certlly that all Inlarmallon in this and all attached documentscerlaln true and accurate descriptions of the waste including that the waste is segregated and is nal comingled with other waste streams.As the Generator.l acknowledge that aur Silt EPA IO:is acllve.The waste stream fisted above complies wilh fha Waste Protlle on record for the designated facility.This document serves as wrillen verification that the waste weam(s)description and cansliluents found above are unchanged per the Facility Generator Waste Profile Worksheet and also acts as the annual wrtIlan verlliea{Ion Ior The Nneralor Waste FmIlle Worksheel of These waste streams.I decfare under panalty of perfury that the foregoing is trueandcnrrect. CleanTech Environmental inc. a 2581 S. StJniand Ave. 0. Fresno, CA 93725 ,DRIVER'S NAME'TYPE 0IRPRINT FULL NAME tn EPA ID #T:CAL000368136 z _ Track, unit ID No. / SIGNATU RE /QATP- a 0 The checked box Is the deslgri&ed recycling facility U' z ❑Roadrunner Glycal,Inc. ❑Sawthwest Processors ❑Heritage Environmental C7 Cleanteeh Environmental a 463E Industrial Center Cir. 4120 Bandid Blvd, Services LLC 5920 Marlin Rd. g U Las Vegas, NV 89115 Verrion,CA 90058 284 East Storey Road Irwindale,CA 91706 w UJI LL EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 95128 EPA#CALOOD330453 a ir Ph#702/379-7179 Pit#80/900-3356 EPA#AZD081705402 Ph#62MI2-7200 Ph#520/723-4167