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i aJ K ICE f � == Cie a n Te ch ' SERVORD RURIi M Environmental Inc. 400251 5820 Martin Road• Irwindale, CA 91706 ' Phone:026-812-7200 WASTE RECYCLING RECEIPT i # Noma a Customer Purchase order a AddreSj:5 N Sales Representative C i City. State. ZipLodj CA Phone c _ r- EPA 10#:_ �e< 0 Do 21 t 1 Federal Manifests: 0op 1 6 t, -- M2- UNITS I U.S.DOT DESCRIPTION CHARGE GAL USED OIL-NON RCRA HAZARDOUS WASTE.LIQUID Uj CA WASTE CODE 221 GAL USED ANTI-FREEZE-NON RCRA HAZARDOUS WASTE,LIQUID CA WASTE CODE 135 - OILY WATER FROM USED PARTS WASH SOLUTION- GAL. NON-RCRA HAZARDOUS WASTE.LIQUID, CA WASTE CODE 134 - RUM{5j DRAINED USED OIL AND GAS FILTERS I h e 4�1 Q 1 I bs $ G S — A TOTAL LUUJI The above used oil is %Lubricatingoil 1.5% ACCOUNT STATUS- C-0.p. 9h Indla8en oil ( } t ]OPEN ACCOUNT lr open Account-Payment is due not 3O delys or a finance charge 011.596 IL per month will apply. 2 key that s Q GENERATOR'S ROT MATION AND CERTIFICATION:Arty used dl Thal the transporter receives imm the yenerylor wllt be transported 10 a dertifled used od recyciclq fac n asat is 1 fully and C.) lawful}dpetahrq 1n a[Sovdance m1h a halNtldus waste lacilihts permit rl5ued pursuant to IM",al Act 1 he"try declare that the--is o1 this consignment are fully ane t dy 0 O.T LU accurately described above by the proper OOT shipping name aro ate ciassllred.parkaged marked•and labeled and ate in as asWT5 in proper condrtlan fw transport by 0 0 T id attorney m standards All rarevaril information regarding known a SVSpected hazards assocraled with Thrs waste has been digctasetl The COSlmtrer agrees to,pay reasonable cosi and attorney vied w 40 lees Incurred m the cokectron of INS obingetm venue for purposes of MISobl,gatlon shall be+n Las Angeles County I certlty that the waste rllln"LZIllgn statement identified in 40 1 both frond F CFR 2622712ipi I arts huge quantity gendralnrr or M id f am a smaN quantity 4enrratorl is true.l also acknowk"tNT I Tuve read and agree to the terms ort this ldrro both from Nor 12mg Me ane back signer guarantees The paymenl or creliaKh mvarces in accordance with the standard terms of Nei 30 days u a Purchase Order is n of issued.the employee aulhonrhiq The et X days work perlolfiM yua{ashes That any M,mrras presented will be pa d prgmplty Prpmpl Payment is Ohnad as payment 1n accordance wdh CleanTeui standard Terms of Am 3U days IIATERIALS rnvorce paymanl 15 riot contingent upon paymenf oy a m,ro party Int@rest on past due accouats will be crorged a1 The rate of 15%pro moalh unto paid in Tulp WASTE MATERIALS WHICH AREDISCOVERED TO BE NON-ccwrORNING WILL BE SUBJECT TO ADDITIONAL CHARGES, ff TYPE OR P;IINT FULL NAME SIONATURE DATE L" as Thar k1h I hereby canny mal I have read and have the authOnty to bind Itt above Idled generator to the term$found on both the boot and back of this loim Sot@ Law re9uire5 Rrat tmlh DO 3".rale the Generator and Transporter keep this form on bra Tor a minimum of(3]years I hereby certrly that all rnformebo-n.n ihls and all anacw documerils conlam I've end accurate s actwv The descriptions of The waste alcluding 1411 rhe wastes S"etilaied and is opt ca-Ved wilh usher waste streams As nm Generalm-I achwe lot nut PUS"EPA 10 141111011,111.ecltw•The daseHpllon I iaa5re 51 ream listed abort oornprras wrth rhe waste ProhR on record for the ftsigoared Facdiry ThI=dereTeaf fefWe ae ulnae YIttHCaHen lhet IM walla alpamle)laiptPllpp taste Prellla sod wrlrtiluents loond above are aachanEed per the 1`410"T 011HUtor W11111e Profile Wad isAeet and alio aais as the annual written nrtkarcion far die Geaeralor Waage PION Wortsheel of Ihese waste streams-i iwwre utder penalty of penury InAl Ine roreyoing 4S Pus and coned ¢ CleanTech Environmental Inc- 5820 Martin Road LLA rd La� a Irwindale, CA 91706 ! d DRIV NAME•TYPE OR PAINT FULL NAME rn EPA ID M:CAL004330453 {r, 7 Y I5 V 2 l� Truck. Ur Id No. SIGNATURE DATE The checked box is the designated recycling facility ?� El US Ecolow Vernon 13 Lighiinq Resources 12 Patriot Waste Water 7 Hentage Erimmrnental �14120 eantech Emiomrr,erdal lmenlal X75$.Boyer Ave 805 East Frances Strict 314 W Freedom Ave. ServlcEs ILC Martin R4. 146 } Vernon.CA 90058 Onlarlo•CA 91 M1 Orange.CA 42865 284 East storey Ad. Irvrlrldafe,CA 91746 4453 X 0 LL EPA) Ur EPA)CAR000156125 Ph i 85-51 M6-4299(24-Dispatch) C0011dot•A785128 E"A#CAL000330453 .00 UJ pt,4 800/266-7747 Ph i 909923.7252 Ph 1I 714/921.4545 EPA 0 k7DOS1705402 Ph 162&1312.1200 Ph 0 524+23-4167