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1eanTech == SERV ICC WORK ORDER Environmental Inc. 148586 2581 S. Suniand Ave. o Fresno, CA 93725 Phone. 804-531-9683 WASTE RECYCLING RECEIPT- !Name: 41f grl Customer Purchase Order# Address: .15-1 -,- .1 libit Service Technician TC City, State, Zip: C�gll' Phone #: EPA ID #: ;:J��ori2 Federal Manifest#: � � � s QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE GAL USED OIL---NON RCRA HAZARDOUS WASTE, LIQUID 0 CA WASTE CODE 221 GAL USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID a: CA WASTE CODE 134 GAL, OILY WATER FROM USED PARTS WASH SOLUTION— NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE COBE 134 ccW Z DRUM(S) DRAINED USED OiL AND GAS FILTERS L�3 W O TOTAL 1— J The above used oil is % Lubricating oil % Industrial oil a. ACCOUNT STATUS: { C-0.D. ( )OPEN ACCOUNT If open Account- payment Is due net 30 days or a finance charge of 1.5% :E per month will apply. a U OENEHATOKS NOTIFICATION ANI)CFRTIFICATION, Any used oil that the transporter receives from the generator will be transported to a ceriiNd used oil recycling facili- Lu ty that is lawfully operating in accordance with a hazardous waste facilities permit issded pursuant to the Federal Act. i hereby declare that the 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 Q for transport by higt+way=01ding to applicable national rogufatimS. All relevant information regarding known or suspected hazards associated with this waste has been 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 he 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 labeled/placard,and are in all respects in proper caridltion for transport according to appii- cable and national governmental regulations. If export shipment and 1 am the primary Exporter,I certify that the contents of this consignment conform to terms of the attached EPA Acknowledgment of Consent. 1 certify that the waste minimization statement identified in 40 GFR 282.27(a)(it I am a large quantity generator)or(b)(it I am a small quantity generator)is true. I hereby certify that all Informallorn 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 hack. 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 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%per mg th until paid.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON-CONFORMING WILL 6E SU .I ECT TO ADDITIONAL CHARGES. TYPE OR PRINT FULL NAME IGNATWE DATE I hereby certify that I have read and have the authority to hind the above listed generator to the terms on the reverse side of this form. State Law requires that you keep this FteceiptiBill of Lading on Fite for no less than(3)years. Clean Tech Environmental Inc. LU 2581 S.Sunland Ave. It Fresno,CA 93725CL TYP PRfNT FULL E CO) EPA ID#:CAL000368136 IrIr Truck, Unit ID No. 45IGNATUR DATE The clocked box is the designated recycling facility W Z ❑ Roadrunner Glycol, Inc. Q Southwest Processors ❑ Heritage Environmental Vleantach Environmental :1i 4636 Industrial Center Dr, 4120 Bandini Blvd. Services LLC 5820 Martin Rd. Las Vegas,TUU 89115 Vernon, CA 90058 284 East Storey Road Irwindale,CA 91706 EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 CL CC Ph#7021379-7179 Ph#8001900-3366 EPA#AZD081705402 PH#6261812-7200 Ph#5201723-4167