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Dec 15 21 08 : 18a Payless Auto Repair 209-334-311 v p , 1 R : CEV D ammor E V SERVICE 'WORK � CleanTechORDER DEC.'Q, 9 2021 Environmental Inc. 2581 S . _ Suniand Ave. • Fresno, CA 93725 172467 ENVIRONMENTAL HEALTH Phone : 800- 531 *s9683 DEPARTMENTVICi4 T' RECYCLING REEI PCD CDO.) 1`� � r nn Name: P. ti G Customer Purchase Order # Address: A I P.Arotvi. 4 U Ist j Sales Representative City, State, Zip : r ' MCAA . QE.b Phone #: EPA ID #: C r() Federal Manifest * Lot QUANTITY UNITS U . DESCRIPTION CHARGE t� GAL. USED OIL NON RCRA HAZARDOUS WASTE , LIQUID E CODE 221 ! c > GAL . USED ANTIFREEZE — NON RCRA HAZARDOUS WASTE , LIQUID CA WASTE CODS 134 OILY WATER FROM USED DARTS WASH SOLUTION Ems GAL' NON -RCRA HAZARDOUS WASTE , LIQUID. CA WASTE CODE 134 DRUM(S) DRAINED USED OIL AND GAS FILTERS (5 i'J V m TOTAL ; L IiJ The above used oil is % Lubricati g oil % Industrial oil ACCOUNT STATUS: ( ) C.O.D. ( ) OPEN ACCOUNT If open Account - payment Is due net 30 days or a finance charge of 1 .5°l0 O. per month will apply. 0 GENERATOR'S NOTIRCATION AND CERTIFICATION: Any used oil that the transporter receives from the generator will be transported to a oeriffied used oil recycling facility that is raj lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act. I hereby do*ciare.lhat the contents of this consignment are fully and 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. 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 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 CFR =7(a)(t1 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, Signerguarantees the payment of CleanToch invoices in aeoordance with the standard terms of N00 days. If a Purchase Order Is not issued, the employee authorWng the work performed guararnees that any invoices presented will be paid promptly. Prompt payment is defined as payment In accordance with CleaaTech standard terms of net 3o days. Invoice payment is not contingent upon payment by a third party. Interest on past due accounts will be charged at the rate of b5% per morith until paid in full. WASTE MATERIALS WHICH ARE DISCOVERED TO BE NONCONFORMING WILL BE SUBJECTTO ADDITIONAL CHARGES. TYPE OR PRINT FULL NAME SIGRATURE TE I hereby certify that I have road and have the authorityto bind the above listed generator to the terms found on both the front and back ofthis form State Law requires that both the Generator and Transporter keep this form on lite for a minimum of (3) years, I heroby certify trial all information In ibis and all attached documents contain true and accurate descriptions of the waste including that the waste is segregated and is not comingled with other waste streams. As tha Generator, ) acknowledge that our she EPA ID # fsactive. The wasto stream lisied above compiles with the Waste Prollle on record for the designated Facility. This document serves as written vorification that the waste stream(s) description and consilluenls found above are unchanged per the Facility Generalor Waste Profile Worksheet end also eels Mile annual wMan vemieatlonforths Generator Wastapfiflle Woritshastol these waste streams. I declare under penalty of perjury that the foregoing Is true and correct. CleanTech Environmental Inc. W 2581 S. Sunland Ave. Fresno, CA 93725 DRIVER'S NAME - TYPE OR PPINfFVLL NAME EPA ID # : CAL000368136 or% l/I fE Truck, Unit ID No. 1 A TE The checked box is the designated recycling facility UJ z 0 Roadrunner Glycol , Inc. 0 Southwest Processors 0 Heritage Environmental Cleantech Environmental r ,J 4636 Industrial Cerner lir. 412D Banditti Blvd. Services LLC lea Martin VIr e Las Vegas, NV 89115 Vernon, CA 90058 284 East Storey Road Irwindale, CA 91706 Lcc ist 0List < EPA # NVROOD088427 EPA # CAL921646037 Coolidge, AZ 85128 EPA # GALOOD330453 p, p� Ph # 7022379-7179 Ph # 800/900-3366 EPA # AZD081705402 Ph # 626/812-7200 Ph # 524/7234167