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SERIVICE-AIL <br /> CleanTech <br /> SERV E WORK <br /> RdER <br /> Environmental Inc. 9 5 Q 5 5 <br /> 2581 S.Sunland Ave. • Fresno, CA 93725 <br /> Phone:800-531-9683 <br /> WASTE RECYCLING RECEIPT <br /> Name; Customer Purchase Order 0 <br /> Address: Sales Representatn+e <br /> City, Stater Zip: L-w•f'•' G , Phone <br /> EPA 11)N. Federal Manifest#:a--? of S r <br /> OL)ANTITY UNITS U.S.DOT DESCRIPTfON CHARGE <br /> or ` GAL USED OIL-NON RCRA HAZARDOUS WASTE,LIQUID <br /> CA WASTE CODE 221 <br /> GAL. USED AN-0-FREEZE-NON RCRA HAZARDOUS WASTE, LIOUID <br /> CA WASTE CODE 134 <br /> OILY WATER FROM USED PARTS WASH SOLUTION- <br /> GAL' <br /> NON-RCRA HAZARDOUS WASTE,LIQUID. CA WASTE CODE 134 <br /> 1 <br /> LU DMMfS] DRAINED USED OIL AND GAS FILTERS <br /> 2 <br /> LaiY <br /> TOTAL -- <br /> C <br /> - The above used oil is .,Lubricating oil %rndustriai 03 <br /> t— <br /> LU ACCOUNT STATUS: f ]G.O.Q. f 1 OPEN ACCOUNT If open Account-payment Is due net 30 drys or ae tthanrce charge of 1-5`6 <br /> ■ �'' & per month wfll apply. . <br /> 0 eENERATOR$NOt1FICATION AND CFRTIFICATIOJI'Any used oil that the uanspOrter recam from mC gertratdr wig be Irnnported to a eera'fied used od rKyebrig tivICy thal a <br /> 0 Fa•.YrA operating In w-tvdar"with a mardous'Haste laaritles Permit wued pursuant to the Federaf Act I huery denl7re tful ole win"n2s 01 lrus consgnaieht art hilly ano <br /> 1LF XeurjWy d#Criped NKNg by VIA proper DOT srlrpping risme and are classrtied.packaged,marked,and tanded and are in as a3pect5 in ofoper wrdmm our truzwn by D.o T. <br /> ft] svrdards AR n t vwl mfprmapdn reprdatg Mown dr suspected hazards associated with this waste has bell disddaed.lfle CUStX1W ageM to nay rrasanabre pest and aaWfrey <br /> fees naruredn tw WA%'bdrl of IhrS ObfiQ w Vetrue fpr PUTOM W Angeles County 00gal�on shat be M LOS ACounty I Ce&o INI ttx waste nenimrahpn SJa rmnt iBtntrhed in 40 <br /> UA M227falm I am a lugs ix&Wy gerkraCor)or fill)fit 1 am a small quarrtrty generator}JS true.I aiN aCkrlpllledge SW I lave read ass agnK to the terms W Inds form Odor trent <br /> and back svfw guar mees the aaymeat ar ClemTech hwortes rn atCmatrltr wdh the stafldard terms of Mat 30 rays N a pumriase Drder is hot issued.a*wrioeiyee auroff mg the <br /> work pototnned gW rahttts MA any mom presented rnlf be prd promptly.Prolnpl Wmwm a defined as payment in acitordante wilt Calmleo standard terms of net 3G don <br /> f tiflrre piirnem rs rrol.ortl;rlg.•n!upon payment by a mod parry into rtst on past due arcoehrf+np be charoed al die rate of 1 5%per rn"utrlh p d m td-NAM MATERIALS <br /> WHICH ARE DIECMRED TO K NW-CONFORMINO WILL K SUII.IECT TO ADOITIORU CHANGES. <br /> T t <br /> TYPE OR PRINT FULL NAMIE SIGNATURE DATE <br /> . ' i fler w cv*tha I him rod and Uira the atRk ty to bled Iha abdre MSW generator in the INR1f found On bdUl ills hent aM bad of Ina loan.Stale Law rMwa vol troth <br /> �. the Gerlerarof and Tr&npdrW kelp the form on 5M 1041 rmnlmum of{31 years I hereby certdy INN all miprmalron in this and all jnarhM]orurxnT5 rorrain true Olid accurate <br /> -f d1nurlprlori5 or cite MrnS r m(illdrng IPM the w75r4 r5 igrepaled and is not wmlPoled with onion waSte sheams AS me Gede ral or I aLkne*m,0Qe f!o:; 5•7e EDA C:if IS a[.iVP The . <br />! wawa s-.fw hVed abo"Gdmplres with The wide Roflie on record for me desrgnaud Faculty Tkif dusereat ferns se wrote*rerW4"Ela pat pre was"S"anlsl 4iaunpiia f <br /> �+ r and wraudeata 10OW elan an wahlnpad Gin <br /> valor Me Ficif4 Gi eralor Waste Plaint Wwhboel and ssn atso aas the annealtten wiwaltatf <br /> rian for nae Generator Waite Prot% <br /> Ww1tflreal el Imasir wide fWahRf.I OKI;ra under Warty of perjury that tiro foregoing o live and correct. <br />+ CfeanTech Environmental Inc. <br /> 2581 S.SUnland Ave. 114 A AC <br /> Q Fresno, CA 93125 <br /> D RIVER'S NAME- EOR PRINT LL NAME <br />` 0 EPA 1D N:CALOOD368136 <br /> f� Lr f L d <br /> TrUCk, Unit ID No. SIGNATURE DATE <br /> I <br /> y The cflecked box is the design ted recycling facility <br /> R C C9 <br /> u� ©Roadrunner G�col,lnc- ❑Scuthwest Processors ❑Heritage Environmental Q Cleanlech Environmental <br /> 4636 indostrial Center Dr. 4120 Bandlni Blvd. Services LLC 5$217 Wrtin Rd- <br /> Lets Vegas,NV 89115 Vernon.CA 90058 284 East Storey Rciad Irwindale.CA 91706 <br /> 4 EPA f NVR+?0 BU27 EPA#C4921646037 Coolidge,AZ 95128 EPA I CAL0DMO453 <br /> Ph 17021379.7179 Ph 18001900-3366 EPA f AZ008170M402 Ph 1621'�J812.7200 <br /> Wj <br /> Ph 15201723.4167 <br /> L <br />