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cc <br />O <br />Q <br />LU <br />Z <br />W <br />O <br />Cal <br />0 <br />LLI <br />F— <br />LU <br />J <br />CL <br />2 <br />O <br />0 <br />W <br />m <br />O <br />F— <br />�CleanTech== <br />Environmental Inc. <br />2581 S. Sunland Ave. • Fresno, CA 93725 <br />Phone: 800-531-9683 <br />WASTE RECYCLING RECEIPT <br />SERVICE WORK <br />ORDER <br />172000 <br />Name: Customer Purchase Order # <br />Address: Noel Tabora 308 M Cherokee Lane Sales Representative ipi <br />City, State, Zip: LAdj CA 955940 Phone #: <br />209-369431 A �1 ` <br />EPA ID #( !-t�'Cl ,�;r f_ :7 Federal Manifest #: <br />QUANTITY <br />UNITS <br />U.S. DOT DESCRIPTION <br />CHARGE <br />0 O <br />GAL. <br />USED OIL — NON RCRA HAZARDOUS WASTE, LIQUID <br />S <br />LU Z H <br />CA WASTE CODE 221?` <br />❑ Southwest Processors <br />❑ Heritage Environmental <br />GAL. <br />USED ANTI -FREEZE — NON RCRA HAZARDOUS WASTE, LIQUID <br />4636 Industrial Center Dr. <br />4120 Bandini Blvd. <br />Services LLC <br />CA WASTE CODE 134 <br />U v <br />Las Vegas, NV 89115 <br />GAL. <br />OILY WATER FROM USED PARTS WASH SOLUTION — <br />Irwindale, CA 91706 <br />Lu Lu tai <br />EPA # NVR000088427 <br />NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 <br />Coolidge, AZ 85128 <br />EPA # CAL000330453 <br />DRUM(S) <br />DRAINED USED OIL AND GAS FILTERS <br />Ph # 800/900-3366 <br />EPA # AZD081705402 <br />Ph # 626/812-7200 <br />'N <br />Ph # 520/723-4167 <br />TOTAL TOTAL <br />The above used oil is % Lubricating oil % Industrial oil <br />ACCOUNT STATUS: () C.O.D. () OPEN ACCOUNT If open Account - payment is due net 30 days or a finance charge of 1.5% <br />per month will apply. <br />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 <br />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 <br />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. <br />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 <br />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 <br />CFR 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 <br />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 <br />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. <br />Invoice payment is not contingent upon payment by a third party. Interest on past due accounts will be charged at the rate of 1. % per month until paid in full. WASTE MATERIALS <br />WHICHARE DISCOVERED TO BE NON -CONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. <br />T PE OR PRINT FULL NAME S GNA R DAT <br />I hereby certify that I have read and have the authority to bind the above listed generator to the terms found on both the front and back of this form. State Law requires that both <br />the Generator and Transporter keep this form on file for a minimum of (3) years. I hereby certify that all information in this and all attached documents contain true and accurate <br />descriptions of the waste including that the waste is segregated and is not comingled with other waste streams. As the Generator, I acknowledge that our site EPA ID # is active. The <br />waste stream listed above complies with the Waste Profile on record for the designated Facility. This document serves as written verification that the waste stream(s) description <br />and constituents found above are unchanged per the Facility Generator Waste Profile Worksheet and also acts as the annual written verification for the Generator Waste Profile <br />Worksheet of these waste streams. I declare under penalty of perjury that the foregoing is true and correct. <br />cc CleanTech Environmental Inc. <br />2581 S. Sunland Ave. <br />O Fresno, CA 93725v �ti <br />t/a EPA ID #: CAL000368136 D E SNA T PE OR PRINT FULL NAME <br />Z <br />a <br />Truck, Unit ID No. 7,-.. SIGNATURE DATE <br />The checked box is the designated recycling facility <br />0 O <br />LU Z H <br />❑ Roadrunner Glycol, Inc. <br />❑ Southwest Processors <br />❑ Heritage Environmental <br />❑ Cleantech Environmental <br />v _J <br />4636 Industrial Center Dr. <br />4120 Bandini Blvd. <br />Services LLC <br />5820 Martin Rd. <br />U v <br />Las Vegas, NV 89115 <br />Vernon, CA 90058 <br />284 East Storey Road <br />Irwindale, CA 91706 <br />Lu Lu tai <br />EPA # NVR000088427 <br />EPA # CAL921646037 <br />Coolidge, AZ 85128 <br />EPA # CAL000330453 <br />a tr <br />Ph # 702/379-7179 <br />Ph # 800/900-3366 <br />EPA # AZD081705402 <br />Ph # 626/812-7200 <br />Ph # 520/723-4167 <br />