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y SERVICE WORK eChORDER Environmental Inc. 198350 2581 S. Surtlarld Ave. - Fresno, CA 93725 Phone:880-531-9683 WASTE RECYCLING RECEIPT Name: Customer Purchase Order Address: Sales Representative City, State,Zip: du C1+ Phone#: EPA ID #: Federal Manifest#: 4)2 13 -37 QUANTITY UNITS U.5-DOT DESCRIPTION GHARGE GAL USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 221 GAL. USED ANTI-FREEZE—NON RORA HAZARDOUS WASTE, LIQUID CA WASTE COLE 134 Cc OILY WATER FROM USED PARTS WASH SOLUTION— aGAL, NON-jHCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 DRUM(S) DRAINED USED OIL AND GAS FILTERS � GL.nf S A TOTAL UJ The above used oil is %Lubticating ail k Industrial oil LU ACCOUNT STATUS: }C.Q.D. { )OPEN ACCOUNT If open Account-payment Is due net 30 days or a finance charge of 1.5% J t% per month will apply. Cy GENERATOR'S NOTIFICATION AND CERTIFICATION-Any used oil That the Transporter receives from the generator will he transported to a certified used all recyaiing facility that Is { lawfully operating in accordance with a hazardous waste facilities parmiL lSSuad pursuant to She Faderal Act, I hereby declare that the Contents of Ihis constgntnent are fully and accurately des0bed above by the proper COT shipping name and are classified,packaged,marked,and labeled and are in all aspens In proper Wndllron Tor transport by O.O.T. 03 standards.All relevant information regarding knmvn or suspected hazards associated with this waste has been disclosed.The customer agrees to pay reasonable cost and attorney O lees IuCurred in the collection of this obligaslon.Venue for puipmos of this obligation shall be In Los Angeles Gounly.I cattily That lho waste minimization sialement idanilffed in 40 }- CFR 25227(a)(ii f am a larga quantity generator)or(b)(if I am a small quantity generator)Is tale.I also ackmmvledge that I have read and agree to tha Terms an Ihls lnrm both Tram and hack.Signer guarantees the paymenl of CleanTeO invdlcas in accordance with the standard terms of Net 30 days,if a Purchase Order is not issued,the emproyee awh or4ing the work performed guarantees that any invoices presented will be paid promptly.Prompt payment Is defined ay payment in accordance with CleariTeh standard terms of net 30 days. ihvolce payment Is nol contingent upon paymenl by a thin!party.Inlemst on past due accounts will be charged at the rale of 1.5%per month until paid in Trot.WASTE MATERIALS WHICH ARE DISCOVERED TO HE NON-CONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. ' TYPE D»PRINrT FULL NAME $I TURF DATE I hershy cerllfy thal I have read and have the avnforily to bind the above IlsUd generalor to the terms found on both the front and back or this form.Stale Law requires that both the Generator and Transporter keep Ibis form on Lilo for a minimum of(3}years.I hereby certify that ah lNormatlon In this and all attached dmurnants aor,.Wn True and accurate descrlpllons of the wasre Includlog that the ws ole Is segregated and is not com inpled with other waste streams.As the Generaloi,I acknowledge chat our siW EPA 10 a is adlve.Thu waste stream listed above Cvmplles with the Waste Profile on record for the daslgnawd Faultily.This document serves as written ver[Malfon that Tho waste slream(s)descNplloo and cerislildents found above are unchanged par the Facility Generator Waste Profile Work,'heat and also actsas the annual vrthlan vernleallon for the GeneratarWaale Proola Worksheet of these waste streams.I declare Orlder penalty oI perjury that the foreminrg Is trzle and correct- eu LGleanTech Environmental Inc. 2581 S.Sunland Ave. Girt 0. DRIVER'S CA 93725 DRTVEFI'S NAME-"TYPE OR PRINT FULL NAME to EPA to#:CAL000368136 z cc Truck, Unit ID No. S)fl11AURE DATE The checked box is the designated recycling facility 2 11 Roadrunner Glycol, Inc. ❑Southwest Processors C3Heritage Environmental leantech Environmental U I4636 Industrial Center pr. 4120 Bandini Blvd. Services LLC 5B20 Martin Rd. a >- fa Las Vegas,Nil 69115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 w w< EPA#NVR00005B427 EPA#CAL921646037 Coolidge,AZ 8512a EPA I CALODD330453 eL OC Ph#7021379-7179 Ph#8401900-3366 EPA#AZU081705402 Ph#6261812-7200 Ph#5201723-4157