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Jan 06 2212 : 25p Payless Auto Repair 209-334-3115 p . 2 SERVICE WORK CleanTech ' ORDER Environmental Inc. 2581 S. Sunland Ave. Fresno, CA 93725 17 ,2467 Phone: 800-531 -9683 WASTE RECYCLING RECEIP Name: L� G Customer Purchase Order # , Address : Ur Sales Representative City, State, zip: fi�A AA 0 1 AI Phone #: ll EPA ID #: 91 Federal Manifest QUANTITY UNITS . U. DESCRIPTION . CHARGE `Z " " r� GAL. USED OI NON RCRA HAZARDOUS WASTE, LiQUID v E CODE 221 GAL. USED ANTI-FREEZE — NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 0 OILY WATER FROM USED, PARTS WASH SOLUTION END - GAL. NON-RCRA HAZARDOUS WASTE , LIQUID. CA WASTE CODE 134 d DRUM(S) DRAINED USED OIL AND GAS FILTERS C'3 O TOTAL d lie I WThe above used ori is % Lubricatl g oil % industrial oil rACCOUNT STATUS : ( ) C.O. D. . 20UNT Ii open Account - payment Is due net 30 days or a finance charge of 1 .596 136 per month will apply. VGENERATOR'S NOTIFIGRION AND CERTIFICATION; Any used o6 that the transporter receives tram the generatorwill be transported toil Carlified used oil recycling faog'dy timet 15 lawfully operating in accordance with a hazardous waste facilities permlt issued pursuant to the Federal Act. I hereby declare that the contents of this consignment are July and full accurately described above by the proper DDT shipping name and are classified, packaged, marked, and labeled and are In all aspects In proper condition for transport by D.O.T standards. Ail relevant information regarding known or suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable cost and attomey C3 fees Incurred 16 the collection of this obligation. Venue for purposes of this obligation shelf be in Las Angeles County. I certitythat the waste minimizatian statement ide+diiled in 40 CFR 26227(a)(V I am a large quantity generator) or (b) (it 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 whh the standard terms of Net 30 daysw if a Purchase Orderts not issued, the ornpioyoo authorizing the work performed guaraniess that any invoices presented will be paid promptly. Prompt payment is defined as payment In accordance with CleanTech standard terms of net 30 days, Invoke 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•COHFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES , wwwMwwww V � ":FA L L TYPE OR PRINT FULL NAME � S ATt1RE DATE I hereby certify that 1 have read and have the authority to-bind the above listed generator to the terms found on both the lront and back of this form. State Lava requires that both the Generator and Transporter keep this lam on file for a minimum of (3) years. I hereby certify that all information in this and all attached .documenis contain true and accurate: descriptions of the waste including that the waste Is segregated and is not comingied with other waste streams. As the Generator, I acknowledge that our she EPA ID d is active. The waste stream fisted above complies with the Waste Profile on record for the designated Facility. This document serves as written verification that the waste srrears(s) description _ Bod constituents found above are unchanged Per 1110 Facility Generator Waste Profile 1110110001 and also gots as toe anneal when vadfiicathiP forU a Generator Waste Nelle Woriisheet of these waste streams. I declare under penalty of perjury that the foregoing is true and porreot. . c>w CleanTech Environmental Inc. a2581 S . Sanland Ave. (a, y Pei p Fresno, CA 93725 F F I DIRIVIE is NAME - TYPE ORP NT FULL NAME EPA ID # : CAL000368136 C4 )r I /l Truck;, Unit ID Now f i I DTE The checked box is the designated recycling facility pr ❑ Roadrunner Glycol, Inc. ❑ Southwest Processors 0 Heritage Environmental 420 ntech Environmental U J 4636 Industrial Center Dr. 4120 8aridiN Blvd. Services LLC Martin Rd . U las Vegas, NV 89115 Vernon,eGA 80058 284 East Storey Road Irwindale, CA 91706 1X 0_ Q EPA # M/R000088427 . EPA # CAL921646037 Coolidge, Az 85128 EPA # CAL000330453 a cc u' Ph # 702J379-7179 Ph 0 8001900-3366 EPA # AZD081705402 Ph # 826/812-7200 Ph # 5201723-4167