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O <br />a <br />m <br />W <br />Z <br />W <br />crs <br />r <br />m <br />0 <br />w <br />Lu <br />a <br />O <br />O <br />W <br />Go <br />O <br />00 <br />wzr <br />I: J — <br />J <br />OC 0 <br />CH. <br />L it <br />Name: <br />SERVICE WORD <br />ORDER <br />Environmental Inc. <br />2581 S. Sunland Ave. a Fresno, CA 93725 <br />Phone: 800-531-9683 <br />WASTE RECYCLING RECEIPT <br />5 n f Customer Purchase Order # <br />Address: _ 0S N (li'ir o Le -V lexv%e Sales Representative <br />City, State, Zip: _Lodk" Lti 1524) Phone #: <br />EPA ID #: C.A36 7 Federal Manifest #: <br />iU OV JJ no <br />c53o,7xAZ5"7 WAS <br />QUANTITY UNITS <br />U.S. DOT DESCRIPTION <br />CHARGE <br />GAL <br />USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID <br />CA WASTE CODE 221 <br />�5 <br />GAL. <br />USED ANTI -FREEZE— NON RCRA HAZARDOUS WASTE, LIQUID <br />CA WASTE CODE 134 <br />Coolidge, AZ 85128 <br />GAL. <br />OILY WATER FROM USED PARTS WASH SOLUTION— <br />NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 <br />Ph 16261812-7200 <br />DRUM(S) <br />DRAINED USED OIL AND GAS FILTERS <br />vutYl;%s�` <br />A =i5 <br />TOTAL <br />'7 Z­4.5 <br />rue -uvea esen on IS —% woncaung od % Industrial oil <br />ACCOUNT STATUS: ( )C.O.D. ( ) OPEN ACCOUNT if open Account -payment Is due net 30 days ora finance charge of 1.5% <br />per month will apply. <br />GaIERATOR'S NOTIFICATION Alto CERTIFICATION: Any used ag that the franspoder acd ss Iron the ga stator ww be teansponed to a cerefsad asap aT reWcurg lao'Ety that k <br />(nNuHy operafng m —dance with a h nud.us —1, IacFdFiis permit issued pursuant to the federal Act- I hereby declare that the contents of this consignment are lot, aid <br />-cvre(eif described abme by the proper DOT shipping roma and are datsifad. packaged, marked, and labeled are ed ain.3 aspects in proper eonddien for Iranspou by Der]. AB relevant iMormation regarding trun" or suspected hawds assocktcd With this waste has been disoused The customer agrees to pay reasonable cost and attoRay <br />lees inverted in UK colkcgon of fids oM7gethim Venue lar purposes of Hds obEifiton shad be N Los Areefas County. I cedihy Uel the 11-110 Mnbnhatron sklement ldenUf ul th 40 <br />CFR 26227(aHif I ea a large quaMay generator) or (b) RI I am a small quantity general.) is 11. 1 also adocWtedga ihd I he. read and agree t. the lona on INs term both bort <br />W back Signsr guarantees It. payment of M.Tuh Wok. N accordance with It. standard leets al NM 30 drys 11 a Purchase Order is not issued, the ernpioyee auHw+mog the <br />V.k pedinned guarantees that arty Invokes presorted wM be paid prompiy. Prompt paymerd is defined as payment in acandam With CRanTech standard Lancs of net 30 day, <br />hr.kii pay -A 6 not contingent upon payment by a thiel party. Interest on past due accounts w3l be charged at the rate of 1.6% pr month until paw in tu0. WASTE MATERIALS <br />WHICH <br />/ARE DISCOVERED TO BE;NNO�N/CONFORMIINGG WILL BE SUBJECT TO ADDITIONAL CHARGES. <br />TYPE OR PRINT FULL NAME SIGNATURE DATE <br />I hereby cerSty Thai I have read and We the aulhaity to bind the above luted generelor to the turns found no both the front and back of this form. Sale Law requires that bNM1 <br />IM Generator and Tansponer keep thus form on Re for a mndmum of (3) Years. I hereby cantly that a6 liahm aflon In this and 9 attached documents contain true and allurala <br />descriptions of Ne waste indudky that the waste Is segregated and is not cominglad with other waste streams. As the Generator, l acinaek-0ge that our sea EPA ID 0 is zdix The <br />waste sham listed above complies w1h the Wast, ProfieOn tecord for the destgnated Facility. This d.c,meal serves as curiae- varfriwlion that the,arta sNaam(e) diumpU.. <br />and comfituenth Lound above are,changed per the Facility Generator Waste Profile Vlorksheel and also acts as the annual wdilen veriffcafion lorthe Generator Waste Prowe <br />Worksheet of these walla streams. I declare under penalty of penury that the foregoing k true and cured <br />CleanTech Environmental Inc. ((�� <br />2581 S.SunlandAve, <br />Fresno, CA 93725 Jti I <br />EPA ID #: CAL000368136 DRRIVE�R/SNAME <br />S-1TYPE OR PRINT FULL NAME <br />Truck, Unit 1D No. 22-1w', C/L✓� f�;/:"s.0-t. ��� 111--1(— t`t <br />SIGNATURE DATE <br />The checked box is the designated recycling facility <br />❑ Roadrunner Glycol, Inc. ❑ Southwest Processors <br />4636 Industrial Center Dr. 4120 Bandini Blvd. <br />Las Vegas, NV 89115 Vernon, CA 90058 <br />EPA ;NVR000088427 EPA I CAL921646037 <br />Ph 6 702/379-7179 Ph 8 8001900-3366 <br />❑ Heritage Environmental <br />AleantechEnvironmental <br />Services LLC <br />5820IAafgn Rd. <br />284 East Storey Road <br />Irwindale, CA 91706 <br />Coolidge, AZ 85128 <br />EPA€CAL000330453 <br />EPA # AZ0081705402 <br />Ph 16261812-7200 <br />Ph 1520/723-4167 <br />