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NICT' WORK �- CleanTechi = 0RD R 0 Environmental Inc. 192902 2581 S. SLrnland Ave. * Fresno, CA 93725 1 a phone:800-531-9683 WASTE RECYCLING RECEIPT Name: �—� — Customer Purchase Order ff - Address: - -- - -- Stiles Representative City, Stale, Zip: Phone n: EPA Ip#: CA IZI 7f4 Federal Manifest r QUANTITY 1TSTSECAWASTE T DESCRIPTION CHARGE IL-NON RCRA HAZARDOUS WASTE,LIQUID fi CiAL, TE CODE 221 {_. NOV GAL. NTI-FREEZE-NON RCRA HAZARDOUS WASTE,LIQUID C04E 134 OILY WATER FF1pM USED PARTS WASH SOLUTION- GAL, NDN-RCRA HAZARDOUS WASTE,LIQUID, CA WASTE CODE 134 C WDRUMS] BRAINED USED OIL AND GAS FILTERS 1al i All co TOTAL r 7. ( LILIThe Above used oil is Lubricating oil. %Industrial oil # i �t ' W ACCOUNT STATUS: t )C.O.D- { )OPEN ACCOUNT If open Account- y P payment is due net 30 da or a finance Charge oI 1.5X j (` Ili, per month will apply. 11 C. 0 EEAERill NOTIFICATION AND CERTiFICATIOR;Arty uwd pd Thal the 1rae3pnrter receives ifom the generator WIN 4e tranaportkd IQ k certified used dl recycling facility mit is 4111 0 rawfuly operating re accordance with a hazardous wa51e lacileres permit Issued i to the Federal Act.I heretfy,declare that the writers.of Inns consignment are fuliy end LiJ accurately described aboye by the proper DOT snipping name and are cbssJhed,packaged,marked,and labeled and are In all aspects In proper condhlan for Iraiiwfi by D.C.T. standdres All+elevant inarmalion regarding anoaM or suspected hazards associated wilt,IBIS waste has been d19C105ad The custom+agrees to pay reasanabre Cost and attorney Q fees m{urFed in the cel dlon of this Dbhgalion Venue for purposes of this obhgahon shell lis In Log Angeles CoUnry I Cerliy Thal the waste minlni I n statement identified in 40 r CFR 20271a1iif I am a large quanhty genefalofl or Ib1 illi am a small quantity Venerator)15 trill.I also aCknowledge that I fWye flee SrW agile t4 the leans on this term both front q _ and back.Signer guarantees 1110 pay Merl of CteanTeth invokes M accordance wM h the slandard terms a1 Nei 30 eay5.I I a purchase O der is rat rssuee,the employee aulhai iatric the a; work performed guaraorees Ilial any invoical prestrned will be paid promptly PFafhpt payment re d0ined aS wymenl to accordancevnih Chun-rech ltandard te{mS of net 30 days. G - invoice payrnerr is nal conrinpani udon payment by a third party frferest on past del accO"1115 will W Charged it the rifle or 1.$%per month until paid 1,lull,WA57E MATERIALS .l WHICN ARE DISCOVERED 70 BE NONCONFORMING WItL BE SUBJECT 70 AOOITIOI AL CHARGES, �"fes � �`�'S.�' ` `� l•r f �_�f Y 1 � �} TYPE PRION NT FULL NAME I'Mm SIG AT i . UiiE DATE I hereby certify thdl I have read and have the autltetley to hind the above listed p-aneralor 10 the terms found on troth the front and back of this fDrm Stale Lew fdquiras that beth �^ © the Generator and rfansponer keep this form or file ter a minimum Dl i31 years I hereby artily,that air tntomtation in this and all 02 had documents Contain True and ACCurate descriptions of the waSle intluding that the waste is segregated and Is not conungfrn with other waste streams.As the Generalnr.I acknowledge that oilr silo EPA 10 4 is active The wasle slfeain 1151ed shove complies with bre Wasf t Proflte on record for the designaled FnVhty.This dolumanl serna as written nrincallde that the waste tlreimtll deaeNptlon and constituents lound snore are unchanged per the Facility Ganifalor Wide Rrollts WArllaaat Are also eels as the annual wrillfan earNleellon for the Baearalor Will Prollla Worksheet or these walla tlrti r declare urldai penalty of prrlury Nut the foregoing Is True Arid correct CleanTech Environmental Inc. LU I� - 2581 S.Sunland Ave. 1 ' ❑ Fresno, CA 93725 iEPA 11)#:CAL000368136 DRIVER'S NAME-TYPE OR PRINT FULL NAME f t '• F„ Truck, Unit Ip No. SIGNATURE DAT>= The checked box is the designated recycling Facility ❑Roadrunner Glycol,Inc. ❑Southwest Processors ❑Herftage Environmental4 f 4636 Industrial Center Dr. 4120 Bandlni Blvd, Services LLC Cleantech Environmental �r >1 C1 laS Vegas.NV 89115 Vernon,CA 90059 284 Eas1 Storey Road 5820 Martin Rd. ii W W EPA f NVROCOOS8427 EPA y CAL921646037 Caoiidge.A2 88128 Irwindale,CA 91706 a. Ph 1702/379-7179 Ph 1 800/900-3366 EPA 0 AZD081705402 EPA 1 CALOfl03304g3 � Ph 152M23-4167 Ph*62BM12.7200 ,