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Y� SERVICE WORD �tE��its <br /> Cr <br /> . � CleanTech <br /> I Environmental Inc. 288728 <br /> j r 5820 Martin Road • Irwindale, CA 91706 <br /> Phone: 626-812-7200 <br /> WASTE RECYCLING RECEIPT <br /> Name'. i(rr C i r Customer Purchase order#_— — <br /> ` .�,� • �� Sales Representative <br /> Address. �c� � <br /> City, State,Zip: L r^- - c Phone#: <br /> {Federal Manifest r <br /> EPA ID r} — <br /> W. , <br /> CHARGE C <br /> QUANTITY UNITS U.S.l]OT DESCRIPTION <br /> GAL. USED OIL-NON RCRA RAZARDOUS WASTE,LIQUID <br /> CA WASTE CODE 221 <br /> USED ANTI-FREEZE-NON RCRA HAZARDOUS WASTE,LIQUID <br /> l GAL' CA WASTE CODE 134 <br /> l OILY WATE9 FROM USED PARTS WASH <br /> GAL SOLUTION- — <br /> NO RCRA HAZARDOUS WASTE:,LIQUID, CA WASTE CODE 134 <br /> 44# <br /> D OIL AND GAS FILTERS DRUM(S] DRAINED USE ` <br /> loth l � M <br /> M "TOTAL 0 <br /> Uj <br /> w <br /> 96 Lublicabng oil—%Industrial oil <br /> W The above usad al s t is dt�e eM!30 fts Ora <br /> dr>rnwr e►tar6a of 1,S'r. <br /> d ACCOUNT STATllS: � )C.O.D. f 1 OPEN ACCOUNT 11 open Accounl-peyrrlen <br /> OP�M�will°pply' pr wIN be Irarsported to a cert f ed usto al recynknq rail <br /> �j V GENERATOR,5 NOTIFICATIOR AND CERIIFICAT11 Any used al Seal the transporter su('dre-es s. tiro gerlpe fiereby declare Thai the 91 tr[is 0 <br /> LILI ty that is m mens art 1u lyuand operating <br /> dli Caccordance <br /> ibed 6o ewith try tneaProper$h pp nqrdous W25te �hnarne and tOtS rare el,As o ed.wClraged.marked.and 1u�w a'rd aee o respws insproper condition l <br /> for transport by highway Mcarding Id applvcable national regulations. All reltvanl rnlormalion retarding known lg suspected h8lor pripases tetl with Inrs waste has been 4 <br /> 11-os Angeles Courrly 6 denlareeuM1der�perjury that reasonable <br /> he losego n¢+sI and Srue sand wrrect erehy il In the detu tono are in 0 Iftattthe cdithis nlonls of mleo�ilstpnmeh tulryrana accurately elY deSCr had 4 <br /> A R above Ry the proper Shipping name.ant ars Class tied packaged.Marked.AN and m h 1 pbmarylacald-a I certify that Thhee commis olin rthis conwriment cclIterm ttodition Im transport riterms of the <br /> Cable and national governmentak regulations. 11 expo <br /> rr+f� attached EPA Acknowledgment of Consent. 1 certify that the waste mimmrratbn Statement shed ed in documents <br /> n CFR lain true <br /> {d 1 m ale d quantity peneratwa of(b}Te I <br /> i evantgnfoS on <br /> lrmatlen egandrAg knl+twnuOF suspected ardnsaSSoci all tated writh then in nS 2waSlethaSall aDeen d scldsed c 1 also apI nbwledge that ulaha a reef a d e ord to he It issued. <br /> I this form.both(rant and Hack Signer guaranlees the payment Cleaniech invoices In accordance wllh the slandard Terms p1 Het 30. It a purchase Dido is not issued, <br /> {+ the orm.bemploy"h truntauthorlang the work t0 be gcriormed guarantees that any 1nvOVS preSenl veil be pald promptly. Prompt payment Is defined aS payment in AcColdanCe , <br /> Payment is Hol cpntingem man pa t by a third OanY lnieresl o-n past due accounts writ be charged at the rate of <br /> 1 ynlh CreanTgch standard terms of 30 days lnvdk a pay 6 <br /> 1.5 r month until geld,WASTE MATERIALS WIiICM ARE UISC9VEREp 1G N6 ONFGRMttJF�WILL E SUBJECT 10 A09R10NAL CHARG <br /> SIGNATURE DATE <br /> PE pR PRINT FULL NAME <br /> 1 hereby cerlrly that 1 have lead and have!h9 Out hor+ry to bind the 9BDY0 Vis10d generator l0 1he terms on the reverse Side of this farm. <br /> 1 Slate CAW requues thal you keep thre Rece'09111 OI Lading an fila tor nd lase than(3}yne s. <br /> CleanTech Environmental Inc. l <br /> It Rip �T� OR <br /> w 5420 Martin Read �� yahIrwindale,CA 91706DRI R' NAMELL NAME <br /> s >� EPA ID# CAL000330453 <br /> cn <br />. SIGNATURE DATE <br />�- - Truck, Unit ID No. ' <br /> —�^ <br /> The checked box Is the designated recycling lacility <br /> Heritage Enuironmental Services LLC ti.a••Creari Environmental I <br /> >� z 1f-Pure waterworks I l Crashy a Overton g <br /> I 8914 Rochester Ave. 1610 W.17th Street 284 East Slarey Road 5420 Martin Rd. h <br /> } 5 =� Rancho Cucamonga, tang Beach,CA 90613 Coolidge,A2 85128 Irvylndald,CA 91706 <br /> 2 [) EPA A CA0028409019 EPA#AZOO817C5402 EPA f CALM9330453 4 ���• <br /> CA 81730 Ph N 5621432.5445 Ph 111520r723-4167 Ph#6261812.72M <br /> L L R I a LL Phi 909!76 9492 ♦k 1� <br />