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SERVICE WORK =__ C1eanTech == ORDER Environmental Inc. 151962 2581 S. Sunland Ave. • Fresno, CA 93725, Phone: 800-531-9683 WASTE RECYCLING RECEIPT ' - Name; ECEIPT Name; Customer Purchase Order # Address: -15x'5 Hoff Drive, Service Technician iWI`ISF- City, State. zip: Rinio n CA 96366 Phone #: 663-d62-6-i6 EPA I❑ It: s—AL00 3708012 Federal Manifest QUANTITY UNITS U.S.DOT DESCRIPTION CHARGE GAL. USED OIL— JON RGRA HAZARDOUS WASTE, LIQUID f �i CA WASTE CODE 221 GAL. USED ANTI-FREEZE=—NON RGRA HAZARDOUS WASTE, LIQUID fix CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION— d GAL. NON-RGRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 LU oC Z DRUMS) DRAINED USED OIL AND GAS FILTERS t3 d7 TOTAL W l— Lu The above used oil is %Lubricating oil %Industrial oil Il ACCOUNT STATUS: { J C.O.D. { J OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% 0 per month will apply. L? GENERATOR'S NOTIFICATION ANU CERTIFICATION: Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling fadli- 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- or merit are fatly and accurately described above by the proper shipping name and are classified,packaged,marked,and labeled and are in all respects In praper condition 0 to.,transport by highway according to applicable national regulations. All relevant Information regarding knovrn 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 ohilgatlon 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 fuityandaccurately described above by the proper shipping name,and are classified,packaged,marked,and labeled/placard,and are in all respects in proper condition for tran5poil according to appli- cable and naliona€governmental regulations. If export shipment and I am the primary Exporter,I certlly that the contents of this consignment conform to terms of the attached EPA Acknowledgment of Consent. I certify that the waste m1pimiration statement identified in 40 CFR 262.27(a)of 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 accurate descriptinns 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. In rest on past due accounts will be charged at the rate of 1.5%per month until paid.WASTE MATERIALS WHICH ARE OISCOVERE4 TO BE NON-CONFORMING WIL SUBJECT TO ADDITIONAL CHARGES. TYPE OR PRINT FULL NAMENATURE DATE I hereby certify that I have react and have the authority to bind the abav "fisted generator to the terms on the r rse side of this form. State Law requires that you keep this Receipt/Bill of Lading on}ilE no less than(3)years. o� Clean Tech Environmental Inc. 2581 S.Sunland Ave.fr. ie( v Fresno, CA 93725 PRINT FULL N LO EPA ID #:CAL00036813ti a _57—/,/?_ cc Truck, Unit ID No. �� SIGNATU DATE The checked box is the designated recycling Facility Lu z } ❑ RQadruriner Glycol, Inc. 11 8authwest Processors Il Heritage Env€ronmental Cleantech Environmental U t= 4636 Industrial Center Dr, 4120 Bandini Blvd. Services LLC 5820 Mairtin Rd, > Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 U ¢ EPA#NVROOCO88427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL00C330453 LU cc Ph#702/379-7179 Ph#800/900-3366 EPA 0 AZO 081705402 PH#6261812-7200 Ph#520/723-4167