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1eanTech SERVICE == C == WORK ORDER Environmental Inc. 148604 2581 S.Sunland Ave. • Fresno, CA 93725 Phone: 800-531-9883 s`' z WASTE RECYCLING RECEIPT Name: 5 _ CO Customer Purchase Order# Address: i Service Technician City, State, Zip: ' 5__P0,_f cit- Phone #: EPA I D #:�Q�,79 707 Federal Manifest#: ME QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE GAL USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 221 GAL. USED ANTI-FREEZE— NON RC#RA HAZARDOUS WASTE, LIQUID cc CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION — a GAL. NON-RCRA HAZARDOUS WASTE, LIQUID, CA WASTE CODE 134 w DRUM(S) DRAINED USED OIL AND GAS FILTERS 103 LU C] TOTAL Cr :rC UJ The above used oil is %Lubricating ail % Industrial oil [L ACCOUNT STATUS: ( )C.O.D_ { J OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.59'0 per month will apply. U GENERATOR'S NOTIFICATION AND CERTIFICATION: Any used oil that the transporter receives from the generator will be transported to a certitled used oil recycling facill- Ld ty that is lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act, i hereby declare that iha Contents of this consign- ment are fully and accurately described above by the proper shipping name and are classified,packaged,marked,and labeled and are in all respects in proper condition for transport by highway according to applicable national reguiatians. All relevant Information regarding known or suspected hazards associated with this waste has been I— disclosed, The customer agrees to pay reasonable cost and attorney fees incurred in the collectlori of this obligation, Venue Ioi purposes of this obligation shall be in Los Angeles County. I declare under perjury that the foregoing is true and correct. I hereby declare that the contents of this consignment are fullyand accurately described above by the proper shipping name,and are classified,packaged,marked,and labeledlplacard,and are In all respects in proper condition for Iranspod according to appli- cable and national governmental regulations. If export shipment and I am the primary Exporter,I certify that the contents of this consignment cgnform to terms of the attached EPA Acknowledgment of Consent. I certlfy that the waste minimization statement identified in 40 CFR 252.27(a)(it t am a large quantity generator)or(b)(If i am a small quantity generator)is true. I hereby certity that all information in this and all attached documents contaln true and accurate descriptions of the waste. All rel- evant information regarding known or suspected hazards associated with the waste has been disclosed. I also acknowledge that I have read and agree to the terms on this farm,bath Iront and hack. Signer guarantees the payment CleanTech invoices in accordance with the standard terms of Net 30. 4 a purchase order is not issued, the employee author`iting the work to be performed guarantees that any invoices presented will be paid promptly. Prompt payment is defined as payment in accordance with CleanTech standard terms of 30 days, Invoice payment is not contingent upon payment by a third party. Interest on past due accounts will be charged at the rate of 1.5° ar month unlii-pvd.WASTE MATERIALS WFIICH ARE DfSGQYEREO TO 8E NUN-IyBNFUJIMING WILL DE SUBJECT TO ADDITIONAL CHARGES. I �;14 OR PRINT FULL NAME §J!&NATUR_ DATE I hereby certify that 1 have read and have the authority to bind the above Iistedrgenerator to the terms an the reverse side of This lorm. State Law requires that you keep this I3eceipt/Biil of Lading on file for no fess than(3)years. cc Clean Tech Environmental Inc. LU 2581 S.Sunland Ave, 0 Fresno, CA 93725 CILEPA ID #:CAL000368138 "fGNATLJRE AME Truck, Unit ID No. 1/-20 DATE The checked box is the designated recycling facility W Z h ❑ Roadrunner Glycol, Inc. Southwest Processors ❑ Heritage Environmental 9rcleantech Environmental v 4636 Industrial Center Dr, X4120 Bandini l3ivd. Services LLC r 5820 Mallin Rd. Las Vegas,NV 89115 Vernon, CA 90058 284 East Storey Road Irwindale,CA 91706 UJ LU fx LU IEPA#NVROOOCS8427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 I Ph#7021379-7179 Ph#800!900-3366 EPA#AZD081705402 PH#6261812-7200 Ph#520f723-4167