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=== C =--1eanTech SERVICE WORK ORDER Environmental Inc. 148624 2581 S. SLlnland Ave. • Fresno, CA 93725 Phalle: 800-531-9683 WASTE RECYCLING RECEIPT Name: -9_tvc-0 Customer Purchase Order# Address: Service Technician City, State, Zip: EA C f_� .7 "' �_r Phone #: EPA ID 4: Q1 i 4Cl Federal Manifest #: QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE 12- USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID 1 00 GAL. CA WASTE CODE 221 GAL. USED ANTI-FREEZE—NON SCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION— GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 U.1 U.1 DRUMS) DRAINED USED OIL AND GAS FILTERS L`3 m IJ:JI TOTAL H J The above used oil is %Lubricating oil % Industrial oil ACCOUNT STATUS: ( ) C.O.D. OPEN ACCOUNT 11 open Account-payment is due net 30 days or a finance charge of 1.5% 0 per month will apply. U GENERATOR'S 9MFICATION AND CERTIFICATION: Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling facili- ty that is lawfully operatirig in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act. I hereby declare that the contents of this consign- or 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 Q for transport by highway according to applicable national regulations. Ail relevant information regarding known or suspected hazards associated wile this waste has been I^ disclosed, The customer agreas to pay reasonable cast and attorney fees Incurred In the collection of this obligation. Venue for 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 fully and accurately described above by the proper shipping name,and are classified,packaged,marked,and labeledlplacard,and are in all respects In proper condition fortramport according to appli- cable and national governmental regulations. It export shipment and I am the primary Exporter,I certily that the contents of this conslgnmanl conform to terms of the attached EPA Acknowledgment of Consent. I certify chat the waste minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)or(b)(it i am a small quantity generator)Is true. l hereby certify that all information in this and all attached documents contain 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 form,both front and back. Signer guarantees the payment CleanTech invoices in accordance with the standard terms of Net 30. If a purchase order is not issued, the employee authorizing the work to be performed guarantees that any invoices presented will be paid promptly. Prompt payment is defined as payment In accordance witri Cie Tech standard terms of 30 days. invoice payment is not contingent upon payment ny a thy y. Interest on past due accounts will he charged at the rate at 1.51, er oi*until paid 5TE MATERIALS WHICH ARE DISCOVERED TO BE NON-CONFOR NG LL BE SUBJECT TO ADDITIONAL CHARGES. TYPE OR PRINT FULL NAME 5 RE DATE I hereby certify that I have read and have the authority to bind the above listed gen� for tM1!o the terms on the reverse side of ihls larm. State Law requires that you keep this Fteceipt/Bill of Lading on file for no less Ihart{3}years- Ir Clears Tech Environmental Inc. t- 2581 S.Sunland Ave. ! —Z A�l Alswrl//� p Fresno, CA 93725 (n EPA ID#:CAL000368136 TYP P141N FU AME Fes„ Truck, Unit ID No. SICNATURC DATE The checked box is the designated recycling facifity w Z >_ ❑ Roadrunner Glycol, Inc. 11 Southwest processors ❑ Heritage Environmental �q Cleantech Environmental 71t= � 4636 Industrial Center Dr- 4120 Bandini Blvd_ Services LLC 5820 Marlln Rd. g >. Las Vegas, NV 89115 Vernon, CA 90058 284 East Storey Road Irwindale,CA 91706 0 EPA#NVR400088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 LU LU CL C Ph#7021379-7179 Ph#800/900-3366 EPA#AZD081705402 PH#6261812.7200 Ph#5201723-4167