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leanTech SERVICE � C == WORK ORDER Environmental Inc. 194 9� 2581 S. Sunland Ave. - Fresno, CA 93725 Forane: 800-531-9583 WASTE RECYCLING RECEIPT Name; Customer Purchase Order# Address; - D V—, Sales Representative City, State, Zip: R U G A Phone #: EPA ID#: Federal Manifest #: 2 S Wh- QUANTITY UNITS U.S.DOT DESCRIPTION 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 CC OILY WATER FROM USED PARTS WASH SOLUTION— QGAL' NGN-RCRA HAZARDOUS WASTE,LIQUID. CA WASTE (CODE 134 leu ' DRUM(S) DRAINED USED OIL AND GAS FILTERStu z TOTAL I-- The above used oil is 9G Lubricating oil %Indust0al oil LLI ACCOUNT STATUS: C.O.D. ( f OPEN ACCOUNT If open Account-payment Is due net 30 days or a finance charge of 1.5% G- per month will apply. QGENERArOR'S NOTIFICATION AND CERTIFICATION:Any used oil That the transporter receives from the generator will ba iransporled to a cerllfled used olacycling faculty that Is U 1AV4ully apefating is accDrdance with a hazardous waste Facilities permit issued pursuant to the FWefal Act.I hereby declare that the contersls of this consignment are fully and uJ accurately described above by the proper DOT shipping name and are classillad,packaged,marked,and labeled and are in all aspects in proper condlhonfef transport by 0,01 M standards,All refevmt information regarding known orsuspacted hazards associated with this waste has been disciosed.The customer agrees to pay reasoeabie cost and attorney 0 feaslacurred In Im collection of this obliganon.Uenua for purposes of this abilawwri shall be In Los Angeles Counly,I certify that the waste minimltMipn aielementIdentified In 40 F_ CFR 28227(a)(if f am a large quarduy generator)or(b)(if I am a small quantity venera(or)is true.I also acknowledge that I have read and agree to the lermson III farm both(rent and hack.Signer guarantees the payment of CleanTach invoices In accordance with the standard terms of Net 30 days.If a Pufchase Order is not issued.The employee aur horizing the work performed guarantees Shat any Invoices prasanled will be pald prompity.Prompt payment Is delined as payment In accordance with CleanTech slandard terms of net 30 days. involce payment is flat contingent upon payment by a third party.Interest on past due accounts will be charged at The rate at 1.5%per month until paid In iau.WASTE MATERIALS WHICH ARE DISCOUERFI]TO BENON•CONFORMING WiLLBE SGBJECTTO ADDITIONAL CHARGES. 67 TYPE OR PF4t FULL NAME 5 AT E DATE I haraby"oily line I have read and have the authority to bind Inc above listed generator to the term and do both the front and back of Imis farm.Stafeuw requires that bath the Generator and Transporter keep this form on the for a minimum of(3)years.I hereby cerhfy t t all In in this and all attached documents contain Imo.and accurate descripl Ions of Iha waste InclWtag that the wasters;agregated and is not comingled with other waste slream5-As the Generator,I acknowledge AM aur Bile EPR 10 d is active.The waste stream listed above compiles wllh the WastAfofrle on record for the designated Facility.This deeVmeM1 serves as wrlltO verillcallon that the waste slrearn(s)description and constNuents found above are un6anod parlhe Facility Generator[Haste Profile worksheet and also acts as lha annualwritlan varincallon Iarthe senera(or Wasle Profile Workshael.of these waste streams.f declare under penatlyof pulury that the foregoing is Irue and cafreot. W CleanTech Environmental Inc. 2581 S. Sunland Ave. �r 0 t')� 1 D Fresno, CA 93725 JAm— CL DRIVER' -TYPE OR PRINT FULL NAME Vi EPA ID 1f:CAL000368136 Z I 2 Truck, Unit ID No. Imo! SIGNATURE DATE C1 0 The checked box is the designated recycling facility w ❑Roadrunner Glycol,Inc. ❑Southwest Processors ❑Heritage EnvironmentalI luantech,_nvironmental V 4636 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 15820 Marlin Rd. n 7- [] Las Vegas,NV 89115 Vernon,CA 90055 284 East Storey Road Irwindale,CA 91706 x w EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 LL CL Cc Ph,#702/379-7179 Ph#B00I900-3366 EPA#AZD081705402 Ph#6281812-7200 Ph#5201723-4167