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=., C1e n T h == SERVICE WORK ecORDER Environmental Inc. 14 8 5 9 6 2581 S. Sunland Ave. • Fresno, CA 93725 b_? Phone: 800-531-9683 - � WASTE RECYCLING RECEIPT-~ Name: - _ _ Customer Purchase Order# Address: Service Technician City, State, Zip: 9 '"' Phone #: EPA ID #: ' Federal Manifest#: �-�?� f: - QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE CAL USED OIL-NON RCRA HAZARDOUS WASTE, LIQUID ( � GA WASTE CODE 221 GAL. USED ANTI-FREEZE— NON RCRA HAZARDOUS WASTE, LIQUID a: CA WASTE CODE 134 0 OILY MATER FROM USED PARTS WASH SOLUTION— d GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 ccW Lu DRUM(S) DRAINED USED OIL AND GAS FILTERS C7 M 0 TOTAL f— J The above used oil is %Lubricating oil % Industrial oil CIL ACCOUNT STATUS; C.O-D. OPEN ACCOUNT If open Account- payment is due net 30 days or a finance charge of 1.5% Z per month will apply. 0 0 GENERATOR'S NOTIFICATION AND CERTIFICATION: Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling facili- uJ ty that is lawfully operating in accordance with a hazardous waste facilities permit Issued pursuant to the Federal Act. i hereby declare that the conlenlis of this consign- merit 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 O ter transport by highway according to applicable national regulations. All relevant information regarding known or suspected hazards associated with this waste has been f^ disclosed. The customer agrees to pay reasonable cost and attorney fees incurred In the collection of this obligation. Venue for purposes of this obligation shall be irr 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 laheledlplacard,and are In all respects in proper condition lortiansperl 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 conform to terms of the attached EPA Acknowledgment of Consent. I cerilfy that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. I hereby certify that all Information in this and all attached documents contain true and accurate desdplians of the waste- 1111 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 an this farm,both front and bark. Signer guarantees the payment CleanTech Invoices in accordance wish the standard terms of Net 313, 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 with tlleanTech standard terms of 30 days- Invoice payment is not conlfngent upon payment by a third party. Interest on past due accounts will becharged at the rate 01 1.5%per month until paid-WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON-CONFORMING WILL E SUBJECT TO ADDITIUNAL CHARGES. i::76L - TYPE OR PRINT FULL NAME SIGNATURE DATE I hereby❑ertlfy that I have read and have the authority to hind the above listed generator to the farms on the reverse side o1 this form. State Law requires that you keep this Receipt/Bill of Lading on file for no less than(3)years. ac Clean Tech Environmental Inc. LU 2581 S.Sunland Ave. _ Fresno, CA 53725 TYPE❑ 119INT FULL A rn EPA ID#:CAL000368136 Truck, Unit ID No. A DATE The checked tax is the designated recycling facility � Z Y' ❑ Roadrunner Glycal, Inc. 17 Southwest Processors ❑ Heritage Environmental ' Cleantech Environmental zi U � 4636 industrial Center Dr. 4120 Bandini Blvd. Services LLC 5830 Martin Rd. y Las Vegas, NV 89115 Vernon,GA 94058 284 East Storey Road Irwindale,CA 91706 w EPA# NVR000088427 EPR#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 a cc Ph#7021379.7179 Ph #8001900-3366 EPA#AZD081705402 PH#626)812-7200 Pb#5200723-4157