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le a n Te ch SERVICE ORDERWORK Environmental Inc. -1 2581 S.Sunland Ave. ■ Fresno, CA 93725 �- �- 'Phone:800-531-9683 c WASTE RECYCLING RECEIPT f Name: =n .r, Customer Purchase Order# Address: 't 1Hoff Drives Service Technician HOUSE City, State, Zip: Ripon CA 96366 Phone #: `i61-_?A2-537h EPA ID #: CAL000308082 Federaa Manifest #: 0 QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE GAL USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID} 600 CA WASTE: CODE 221 GAL USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 0 OILY WATER FROM USED PARTS WASH SOLUTION— GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 Lu Z DRUM(S) DRAINED USED OIL AND GAS FILTERS LU 0 — Je- W �(]t TOTAL H 10� LU The above used oil i5 `yo Lubricating all %Industrial all CL ACCOUNT STATUS: { j C.O.D. ( y OPEN ACCOUNT If open Account-payment Is due net 30 days or a finance charge of 1.5% Q per month will apply. L) GENERATOR'S NOTIRCATION ARO CERTIFICATION: Any used ail that the transporter receives from the generator will be transported to a certified used ail recycling faciti- W ty 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- ment are tally and accurately described above by the proper shipping name and are classified,packaged,marked,and labeled and are in all respects In proper condition t for transport by highway according to applicable national regulations. All relevant information regarding known or suspected hazards associaled 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 in Los Angeles County. I declare under perjury that the foregoing is Irve 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 condition for transport according to appli- cable and national governmental regulations. if export shipment and 1 am the primary Exporter,1 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)w(b)(if I am a small quantity generator)is true- f hereby certity that all tnfarmallon 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,bath 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 he performed guarantees that any invoices presented will be paid promptly. Prompt payment is defined as payment in accordance with Clean7ech standard terms of 30 days_ Invoice payment is not conlingent upon payfpqnt by a thi arty. Interest on p due accounts will be charged at the rate of 1. %per manth u i1 paid.WASTE MAT RIALS WHICH ARE DISCOVERED TO BE NON NFORMI G LL BE 3 JE ITIONAL CHARGES. .� � Y-DI -Lyl TYPE OR PRINT FULL NAME IGNATURE DAFE I hereby certify that I have read and have the authority to bind the above listed generator to the terms on the reverse side of this form. Stale Law requires that you keep(his RecelptJf3ill of lading on file for no less than(3)years. rc Clean Tech Environmental Inc. cc 2581 S.Sunland Ave. Fresno, CA 93725 iv—tr-CW.C� uCLi EPA ID#:CALOOD368136 PE OR PRINT LL NAME cc Truck, Unit ID No. C SIGNATORV DATE The checked box Is the designated recycling facility Lu Z } ❑ Roadrunner Glycol,Inc. ❑ Southwest Processors ❑ Heritage Environmental Cleantech Environmental 4636 Industrial Center Dr. 4120 8andini Blvd. Services LLC 5820 Martin Rd. Las Vegas, NV 89115 Vernon,CA 90058 284 East Storey Road I rwindale,CA 91706 EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 8512a EPA 0 CALOO 0330453 4 cc Ph#7021379-7179 Ph#8001900-3366 EPA#AZD081705402 PH#526/812-7200 Ph 1520/723-067