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• Clean `TechSER ORD RORK 0 �Environmental Inc. 198370 2581 S. Sunland Ave. a Fresno, CA 93725 f Phoma:800-531-9683 WASTE RECYCLING RECEIPTM� Name �(r,�,V42 Customer Purchase Order# • Address: Sales Representative 0 • '' City, State. Zip: t. Phone#: i EPA ID #: 1-"" r t Federal Manifest#: Lr-r I QUANTITY UNITS U.S.DOT DESCRIPTION CHARGE y� GAL USED OIL-NON RCRA HAZARDOUS WASTE,LIQUID Fr CA WASTE CODE 221 USED ANTI-FREEZE-NON RCRA HAZARDOUS WASTE,LIQUID ' GAL. CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION- d GAL' NON-RCRA HAZARDOUS WASTE,LIQUID. CA WASTE CODE 134 �) � DRUMS) DRAINED USED OIL AND GAS FILTERS } n. Z r - } d r f c; TOTAL � The above tzSed oil VB 5'a Lubricating oil °Ir,Innfusirla!Oil LU ACCOUNT STATUS: { )C.O,D- l 1 OPEN ACCOUNT If DpAn Account-psyrra"I Is due rW Sp days or s finance chore of 1.5% ` a. per month wl IJ apply. GENERATOR'S NOTIFICATION AND CERTIFICATION:Any used olI that the transporter receives from the generalor will be transported In a candied used oil recychng lediny That Is lawfully vpar3hrr4 In accordance with a huaronus waste lacilhles permit issued pursuant to the Federal Act.I hereby declare that the corderds of lois consignment are Tully and LN accurately described above by the proper DOT shipping name and are dmdted,packaged,marked,and iaboW and are In AN aspects rn proper cundoron for transport by D.D-T. m standards.Al relevant Information regarding known or suspected hazards asslaclaled with inls waste has been disclaAd The CuSlpmaT agrees to pay rusona le cost and attornery fees Incurred to uta Collection of this oollgaVort.Venue for purposes of this oollgaflon shall be In Los Angeles County I certdy that the w2sid minim Talton statementIdenhlYad M4D CPR 292270))it I am a large quantlrygenerator)or{b}(d r am a small quanirty generator)Is true.I also acknowledge stat I rim read and agree to the Terms on this form both front and back.Signer guarantees the payment al CleanieCh Tnvolces In accordance with the standard terms or Ne!30 days.Ila PurChasa Order is not issued,ma employee authorizing[he work performed guaramees That any lnvorcas presented will be paid promptly.Prompt payment Is defined as payment In accordance vmh Cleanro n Standard IerTM of net 3D days. Invoice payment ra not contingent upon payment by a third parry irdarest on past due accirlunls viii be Charohd of the rale of 1.5%per month until pard m full.WASTE MATERIALS WNICH ARE DISCOVERED TO BE NON-CONFORMING WILL BE SUBJECT TO ADOITIONAL CHARGES. f i TYPE OR PRINT FULL NAME SIGNATURE DATtLJ u I hereby cerlify That I clave read and have the authnrny to hind the above listed generator to the terms found ort DWh the front and back of this lorm.Stale Law requires that holh Il r] the Generator and Transporter keep this form on file for a mlmmum of(31 years.l hereby cenity Ihm all Information In this and all attached documents contain true and accurate i ddscriplions of the waste including that the waste Is segregated and Is not commgled with other waste streams As the Generator.I acknow[edge[hat our sne EPA ID I V active The waste slream IlSlad abo-ve eamplles with the Waste Profile on retard fur the designated Facility This document serves as written verlRcalioa that the waste stream(s)description and eonall[uerda found shove are unchanged Dir this Foci lily Gairerator Waste Prattle Worksheol and also ans as The annual written eerilicailon for iha Generator waste Noma a Warksheet of these waste streams.I declare under penalty di pequry that the Toregordg Is lrueand correct. _ [r CleanTech Environmental Inc. LU I`_ 2581 S.Sunland Ave. / �r cc M► - ; a Fresno, CA 93725 -DRIVER'S NAME-TYPE M PRINT FULL NAME EPA ID #:CAL000368136 Li4 - Truck, Unit lC) No. SIG RE DAT rr ��*N ' The checked box is the designated recycling facility �1 W _ yy ❑Roadrunner GIYCOI,Inc. Q SDuthwes#Processors ❑Heritage Environmental ❑Cleantech Environmental J J 4636 Industrial Center Of. 4120 Bandini Blvd. Services LLC 5820 Martin Rd. Las Vegas,NV 89115 Vernon.CA 90058 284 East Storey Road Irwindale,CA 9170.6 r r : ir 0 4 FDA#NVR060085427 EPA 0 CAL921646037 COOlidge,AZ 85128 EPA#CALD00330453 Wi Ph 0 T021379-7179 Ph#BOOMG-3366 EPA#A7D061705402 Ph 4 6261812-7290 Ph 4 52023-4157 1: