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SERVWE WORK r ~ CleanTech =�= a7 R Environmental Inc. ;9R50,65 2581 S.5unland Ave. • Fresno, CA 93725 Phone:804531.9683 WASTE RECYCLING RECEIPT Name: Customer Purchase Order 0 Address: � � f r Sales Representative City, state.Zip: C— i/•' [�/ r Phone:r: f EPA D N: Federal Manifest#:� � � Z 771 i QUANTITY UNfTS U.S.DOT DESCRIPTION CHANGE GAL. USED OIL—NON RC RA HAZARDOUS WASTE.LIQUID CA WASTE CODE 221 Rm+ GAL. USED ANTI-FREEZE—NON RCiRA HAZARDOUS WASTE.LIQUID CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION— - -GAL, OILY HAZARDOUS WASTE,LIQUID. CA WASTE CODE 134 er LU DRUIM(S) DRAINED USED OIL AND GAS FILTERS to - TOTAL 4 G The above used Dil Is .o LubFicatmg oil %irldutgt6ad Ott W ACCOUNT STATUS: ( J C.O.Q ( )OPEN ACCOUNT If open Account-payment Is dm net 30 drys or•finion"I:ihal of 1.5% gg' per month will apply. OGENERATORS NOTIFICATION AND CERTIFICATION:Any uses od that the transporter:wet es ham Um Wwatar no be uNdporied k a avbhed=W ail regrilheat 2m is y laxf;g[ i(pe:avrp M accordance wnh a ramrdaus waste tauhhes permit xsued oumuanl to the Federal Act-I herehy wdaa heat Ow ma nn at m cum m w an%*and ".r#iety 6ncnbed W>7m by the proper VT shrppirig name and ase dz9.V1ed.packaged.marched.and lehafad and arm a ar aSpee<s h pfbpey cramnoe for transport fry 0.(3.1. pundard5 AN afty 7r rtir xmm)oh reparelmg kwwn w suspected ha�rds associated rdlh�crud has tiaan dixd�a The eustatw sprees to pay naz$p A om and attpmey fees rtewred.r etre cdrfetioce of m4 obrgarmn venue for purposes of trtis obhpanon shag tie in Los Angeles County I cemfy Iru1 the w29v tui mwbm statellnetq rdenhded in W � CFR�S227pHd I arlr a trrp6 ylwrury generaforj ar fbl iii I am a srruu gWtntit3r generator}is true.r ansa ac3ulawledQe dud I rlavr regio am spree to hhe eelms on Itis mem bwh nom suet back 0 +r+gt a lm the p inwl of CfanTecfr rrti Wit in ACCardVa wrrth the 5tIAUd tehRS of AM 30 days IIs talrro"Naw is not issued.tree mrplayee aurmun Ute worth ptrforrned QWfirru"dot any!maces presented will the pard prom".Prompt paywni is dehned as payment in accordance with C*mlo;h Sundard ferule of net 3f}6M. rr.w,t paymem is not=. ngem upon pa{-er.;dy a[nerd paetf rntertst on past due xto-unts vfdl be[harped M the rate of 1 5S pN m"unci paad 3n tufl WASTE MATERIALS wmim ARE 0139MUD TO IIs NOM-CORFORMIXG WILL If SULNCT Tt}ADDITIONAL CHARGES, �rrr--r� � �i•}fes � ��f r'r� ryPE OR PRINT FULL NAMES SIGNATURE DATE y All. I rweN certify rW f have read and have the aulMoflly ro 4rnd IRC abm listed generuor to ft terms found on hash dee tem and hack of M4 Faun.state Law rMires teat ba4 L i the Generalor and rransporlar keq Ind form on film for a minimum of 13)Vcats I hereby€efirty 111x1 all efamaucon in IRK end 411 attached documen!5 conti+n IrA aw wxufan l fi �I''ff.+ dtScrrptmns'jf rete Nsle irr,lud:nQ mat the Wava ri Seoregated and lS not comlNW rnth 61hef wASN fatties As Ira Generahu.I atkrwwiedW thal our site EPA Ile*1 rS active.The waste srrrarn 1,5iW about compirts wish the Washm Profile on record lot the detrproted Feebly TNN daotndwt term at wdltm mrtlimo n tlut on waste xbwln(%}duw*daa I �! r Tod conslltneRu 1011114 alta"an wlchsnpad Pts the Fadllty Gtmeralhr waste Prallh WorMsMrl and deo ads as Ilii anal wimp stele s"s Fee er 84rnaratar W -1 kdb WofW"I of these waste flraaf".f def fare under petiarly of pmrlury that the foregoing n Isom and correct. lx CleanTech Environmental Inc. LU � 2581 S.Sunland Ave. !r Fresno. CA 93725 RIVER"S NAME• E OR PRINT PIULL NAME f EPA 10 p:CALOOD368136 I Truck, Unit ID NO. SIGNATURE DATE t[ The Checked box is the design led recycling facility R W Z ❑Roadrunner Glycol,Inc. ❑Southwest Pr ocessm ❑Heritage Fnvlronmental 0 Cleantech EaynnmentW 54636 Industrial Center Dr. 4120 6and1ni Boyd. Services LLC 5$20 Wrtin Rd. y v Las Vegas.NV 58115 Verlton.CA 90658 284 East Storey Road Irwindale.CA 91706 W U EPA f NVRUp0 W27 EPA P CAL921646037 Coolidge,AZ 95128 EPA 0 CALMM0453 Ph,#7021379.7179 Ph 0 801 MG-3366 EPA I AZf}081105402 Ph 0 62012.7200 Ph#5201723.4167 L r