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r Oar <br /> RK <br /> CleanTech SERVORD RDRK <br /> �M <br /> • Environmental Inc. 400251 L <br /> 5820 Marlin Road+ Irwindale, CA 91706 <br />' Phone:526-812-7200 <br /> WASTE RECYCLING RECEIPT <br /> Nam}#a Customer Purchase Order# <br /> Add rest 5 �— <br /> Sales Representative C� <br /> t <br /> City, Stale,Zip1 Phone#: w <br /> E=PA ID#: C-AL OQO 2 It { Federal Manifest#: e— <br /> QUAN7(G3 <br /> T <br /> DOT DESCRIPTION CHARGE <br /> D OIL-NON RCRA HAZARDOUS WASTE.LIQUID <br /> WASTE CODE 221 <br /> D ANT!-FREEZE-NON RCRA HAZARDOUS WASTE,LIQUID <br /> ASTE CODE 135 <br /> OILY WATER FROM USED PARTS WASH SOLUTION- <br /> GAL. NON-RCRA HAZARDOUS WASTE,LIQUID- CA WASTE CODE 134 <br /> W DRUM{S) DRAINED USED OIL AND GAS FILTERS E 141 P.t l b S -1 <br /> Uj <br /> TOTAL <br /> 'r" <br /> r� <br /> IaJ The above used oil is.-..%Lubricating oil_%Industrial oil 1.596 <br /> ACCOUNT STATUS I )C_0-1k t j OPEN ACCOUNT If open Account-payment Is due net 30 days or a finance eh4rgs of 1.59G <br /> a. per month will apply. <br /> Thai <br /> 0 GENERATOR'S NDITFICATtON AND URTIRCATION:Arty used all Thal me transporter recervestrdrn the generator wlh hetrahSlyOried Io aowihed used W amwlrrtg}acuity that rs }fu ky and <br /> U lawfully operating in accordance vnlh a haaardous waste[JeAtles perms,ssad pursuant;0 the Fedtrat All herrby deCiare that the egntenls ql this Ctansbnmern are tiny and r tN D O.T <br /> W auuratery rlescneed appve by pre proper DOT sh ppinq name arid an class tied.pacAaged marked.and Iatreled and ate m ITT aspects 0 proper twnddion for trartspgn by D O T id anpmey <br /> m standards AI relevant rrrfon-neow regardog known or suspected harards aseticraled wrlh this waste has been disNosed.The cusmmor egress Io pay roasonable Casr and attorney ailed in 40 <br /> lKs Wrwrred m The ColleitI qn of This o*Wion Venue for purposes of this 01119b ibn ANTI be in Las Angelis County 1 Cettlfy that the,*gte mknihi aho,sUrement leerdified rn 40 I both from <br /> F CFR 26227fa1 ill I am a Jarpe quantity generator!M IL I rr1 t am a smaw quantity pentratori to true.l also acknowledW the;1 nave road and acres to ft terms ort the form both front tonnng The <br /> and back Signer ouararrees the payment of atanioch invoices in accerdance with The Standard terms of Nat 30 days It a Pmtrtaw Order is nil rssvred.the emroyee paulhortow me oillys <br /> work performed 9uaranTees Thal any rnydras preserved*01 be p44 promolty Prgmpl payment is d0hned as pii Jn accordance Wdh CluoTech standard terms of net 3a days AATERULS <br /> Inyo.ce payment 15 nor contingent upon payment oy a third parry interest on past our a{tpUhts wiD ba charged at the rate of l$%pet month unto paid w fuer WASTE rMATERLkt$ <br /> WHfCH JUTE DISCOVERED TO BE NON-CONFOA MING WILL BE SUBJECT TO ADDITIONAL CHARGES, <br /> l inn •—. V L' <br /> TYPE OR PRINT FULL NA AE SIONATURE DATE as that kill <br /> t hereby carhily prat I have read and have try arJmOrr;y to God Ire above listed generator to me terms round on bath the hunt and back or pus form Slate Law requires that both yid accurate <br /> lite Gone raror and TrarlVertef k$ep this form oh foe for a minimum of M years t hereby ctrtry that air mformahon in this and all attacttrd dpcurwis conlarr Trac and atturato s adrm The <br /> descriptions of The wasit including TNT the waste r5 segrNaled and rs not ComrhpTed with other,wsle streams At IW G4neralm,I isbywlrfdpa Iha}orisMe EPA la a tS acltw.Tor description <br /> wash Stream fisted abavt Cornpltea with the Waate Prohk qn retacd!Or Thr desrgnarrd fao�rdy Thi=40CUMEM Sarni as wuHen rarrAtaH$e That IM wsop marnla}1145alplion hast Praia <br /> irkd conViluehk louad above are mcltanpd pit the Factory Remoter Wast$Pronto warkahen and 4184 TIM as tk Metlal wrlHan rarntealton for[him Gas$ralor Wazot Proem <br /> Wert4hee101 thee$emote Shama,1 dtckre under penatry 01 Penury That the fornioing is true and co(rect. <br /> itF <br /> nTech t=nvironmental Inc. <br /> V0 Martin Road Jf <br /> Ddale, CA 91706 D iJr �1_b Q�t) <br /> N ID#:CA�000330453 DRIV NAME-TYPE OR PRINT FULL NAME <br /> a , oq <br /> k, Unit Ip No. <br /> S GNATURE DATE <br /> ecked box Is the designated recycling facility <br /> Walogy Vernon D lighlinq Rasovrces D Patriot Waste Water ❑Iieritage Emnommental CI�IItorental <br /> 5.Boyle Ave. 805 East Francis Street 314 W.freedom Ave. 5ervict's LLC Marten Rd. r06 <br /> Cn.CA 90058 Onlano,CA 91761 Orange.�A 92865284 East Storey Rd. IlVrindafe.CA9t70fi 0453 <br /> � U W097030993 EPA#CAR000156125 Ph 18451 -4299 R24-Dispet�Clty Coolidge.AZ 85128 EA ff CALO003.30453 .44 <br /> 0. W0Ofi266.774T Ph 1 909'923-7252 Ph#714521-4545 EPA 1 A2{1fl81705402 Ph 1626'812 7200 <br /> Ph#5M3-4167 <br />