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leanTech � SERVICE WORK ORDER Environmental Inc. 151960 2581 S. Sunland Ave. • Fresno, CA 93725 Phone: 800-531-9883 WASTE RECYCLING RECEIPT Name: �r�eerwfl Customer Purr Fla_Qrdar tt Address: if346 Hoff Qviye Service Technician HOUSE City, State, Zip: Ripon CA 9 36Lh Phone #: �'��-��}a�►.� -�! EPA ID #: CAL000 368082 Federal Manifest#: QUANTITY UNITS U.S.DOT DESCRIPTION CHAR9E USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID GAL' CA WASTE CODE 221 GAL. USED ANTI-FREEZE:—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 4 GAL. OILY WATER FROM USED PARTS WASH SOLUTION — NON-RCRA HAZARDOUS WASTE, LIQUID, CA WASTE CODE 134 w W DRUM(S) DRAINED USED OIL AND GAS FILTERS C7 m - TOTAL W hr fPO H _W.1 Thea ave used oil is %Lubricating oil %Industrial oil fL ACCOUNT STATUS; ( }C.O.D. }OPEN ACCOUNT If open Account-payment Is due net 30 days or a finance charge of 1.5% M per month will apply. 0 U GENERATOR'S NOTIFICATION AND CERTIFICATION: Any used ail that the transporter receives Irom the generator will be transported to a certified used oil recycling facili- Wty that is lawfully operating 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 frame and are classified,packaged,marked,and labeled and are In all respects in proper condition 0 for transport by highway according to applicable national reguiallons. All relevant lnformation regarding known or suspecled 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 be in Las Angeles County. I declare under perjury that the foregoing is true and correct. I hereby declare that the contents of this consignment are fully andmeurately described above by the proper shipping name,and are classilled,packaged,marked,and labeled/placard.and are in all respects in proper condition for transport according to appli- cable and national governmental regulations. If export shipment and I am the primary Exporter, l certify that the contents of this consignment conform to terms of the attached EPA Acknowledgment of Consent, I certify that the waste minimization statement identified in 40 CFR 262,27(a)(if I am a large quantity generator)or(b) (it I am a small quantity generator=is true. I hereby certify that all information in this and all attached documents contain true and accurale descriplions of the waste. All rel- evant information regarding known or suspected hazards associated with the waste has been disclosed. I also acknowledge that l have read and agree to the terms an this form, both iront and hack. Signer guarantees the payment ClearrTech Invoices in accordance with the standard terms of Net 34. Il 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 CleaOech standard terms of 30 days. Invoice payment is not contingent upon payment by a third party. Interesl on past due accounts will he charged at the rate of 1-5%perm�/`/p�p`yth until paid-WASTE MATERIALS WHICH ARE DISCOVERED 70 BE NON-CONFORMING WILL BE SUBJECT T ADDITIONAL CHARGES. TYPE OR PRINT FULL NAME Sl NATURE DATE I hereby certify that[have read and have the authority to bind the above listed generator to the terms n the reverse side of this Corm. State law requires that you keep this Receipt/Bill of Lading on file for no less than(3)years. Clean Tech Environmental Inc. LU I— 2581 S. Sunland Ave. i mw_4z 0 Fresno, CA 93725 co EPA ID#: CAL.000368136 FULLIVAME Z Ict Truck, Unit ID No. '4 Z0 A �� SfGNATVM DATE The checked box is the designated recycling facility Lu Z } ❑ Roadrunner Glycol,Inc, 0 Southwest Processors 0 Heritage Envirowental Cleantech Environmental �y 4636 Industrial Center Dr. 4120 Sandini Blvd. Services LLC 5820 Martin Rd. Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 Lu U EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CALD00330453 a LL Ph#7021379-7179 Ph#8001900-3366 EPA#AZD081705402 PH#626/812-7200 Ph#520/723-4167