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CleanTech SERVICE WORK ORDER Environmental inc. 176058 2581 S. Sunland Ave. • Fresno, CA 93725 Phone: 800-531-9683 WASTE RECYCLING RECEIPT Name: Customer Purchase Order# Address: Sales Representati a City, State, Zip: ��, �J� Phone#: EPA ID#: 1'7 Federal Manifest#: QUANTITY UNITSU.S. DOT DESCRIPTION CHARGE GAL. TCA USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID WASTE CODE 221 GAL. USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 cc OILY WATER FROM USED PARTS WASH SOLUTION— Q GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 wc� DRUM(S) DRAINED USED OIL AND GAS FILTE Z W � TOTAL WThe above used oil is '/o Lubricating oil %Industrial oil J ACCOUNT STATUS: ( )C.O.D. ( )OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% a- per month will apply. 0 GENERATOR'S NOTIFICATION AND CERTIFICATION:Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling facility that Is 0 lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare that the contents of this consignment are fully and W accurately described above by the proper DOT shipping name and are classified,packaged,marked,and labeled and are in all aspects in proper condition for transport by D.O.T. DO standards.All relevant information regarding known or suspected hazards associated with this waste has been disclosed.The customer agrees to pay reasonable cost and attorney 0 fees incurred in the collection of this obligation.Venue for purposes of this obligation shall be in Los Angeles County.I certify that the waste minimization statement identified in 40 I-- CFA 26227(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true.I also acknowledge that I have read and agree to the terms on this form both front and back.Signer guarantees the payment of CleanTech invoices in accordance with the standard terms of Net 30 days.If a Purchase Order is not issued,the employee authorizing the work performed guarantees that any invoices presented will be paid promptly.Prompt payment is defined as payment in accordance with CleanTech standard terms of net 30 days. Invoice payment is not contingent upon payment by a third party.Interest on past due accounts will be charged at the rate of 1.5%per month until paid In full.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON-CONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. TYPE OR PRINT FULL NAME SIGNA DATE ,1 1 I hereby certify that I have read and have the authority to bind the above listed general the terms faun both the front and back of this form.State Law requires that both the Generator and Transporter keep this form on file for a minimum of(3)years.I hereby certify that all ormation in this and all attached documents contain true and accurate descriptions of the waste including that the waste is segregated and isnot comingled with other wastes eams.As the Generator,I acknowledge that our site EPA ID#is active.The waste stream listed above complies with the Waste Profile on record for the designated Facility.This d current serves as written verincallen that the waste slream(s)description and constituents found above are unchanged per the Facility Generator Waste Profile Worksheel and also acts as the annual written verification far the Generator Waste Profile Worksheet of these waste streams.I declare.under penalty of perjury that the foregoing is true and correct. cc CleanTech Environmental Inc. 2581 S. Sunland Ave. Ir 0 Fresno, CA 93725 ZEPA ID #:CAL000368136 DRIVERS ME TYPE OR' I T FULL NAME Truck, Unit ID No. �- V I UR The checked box is the designated recycling facility DATE JN ❑Roadrunner Glycol,Inc. ❑Southwest Processors ❑Heritage Environmental Cleantech Environmental v J 4636 Industrial Center Dr. 4120 Bandini Blvd. Services LLC ( 5820 Martin Rd. v U Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 d EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 LU cc LL Ph#702/379-7179 Ph#800/900-3366 EPA#AZD081705402 Ph#626/812-7200 Ph#520/723-4167