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leanTech ` SERVICE WORK ORDER Environmental Inc. 3n4061 5820 Martin Road O Irwindale, CA 91706 Phone: 626-812-7200 -WASTE RECYCLING RECEIPT - Nafne:Srrr� Customer Purchase Order# - Address-i4db IHnff Privp Sales Representative ij0ff_F City, State, ZiP: Rii2or5 CA 1I,1366 Phone #: =r ?62 `` ►� EPA ID #:_ f-at Federal Manifest #: QUANTITY UNITS U.S. DOT DESCR€PTION CHARGE S1GAL USED 0IL—NON RCRA HAZARDOUS WASTE:, LIQUID 00 CA WASTE CODE 221 GAL. USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 Cr. OILY WATER FROM USED PARTS WASH SOLUTION— 0 GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 ti Cr DRUM(S) DRAINED USED OIL AND GAS FILTERS z w too TOTAL LuThea ve used oil is Io Lubricating oil %Industrial ail W ACCOUNT STATUS, { C.Q.D. i )OPEN ACCOUNT if open Account-payment is due net 30 days or a finance charge of 1.5% J a per month will apply. 0 GENERATOR'S N071FICATION AND CERTIFICATION;Any used oil that the transporter receives from the generator will be transported to a certified used ail recycling facility that is 0 lawfully operating in accordance with a hazardous waste facilliies permit issued pursuant to the Federal Act.1 hereby declare that the contents of IhiScnnsignmsnt are fully and LU accurately described above by the proper OCT shipping name and are classified,packaged,marked,and labeled and are in all aspects in proper condillm for transport by Q.O.T. G7 standards.All relevant infunnatlon regarding known or suspected hasards asseclaled with Ihls waste has been disclosed.The customer agrees to pay reasonable cost and attorney fees incurred in the colladion of ihts obligation.Venue far purposes of this obligation shall be in Los Angeles County.I certify that the waste mfnlmIzAnn slatement identifled in 40 CFR 26227(a)(If I am a large quantity generator)or(b)(If I am a small quantity generator)Is true.I also acknowledge that I have read and agree to the termson this form hoM front and back,Signer guarantees the payment at CleanTech invoices in accordance with the standard terms of Net 30 days.If a Purchase Order is not Issued,the employee authorlting the work performed guarantees that any invoices presented will he paid promptly.Prompt payment is defined as payment in accordance with GleanTach standard terms of net 30 days. Invoice payment is col contingent upon payment by a third party.Interest on past due accounts will be charged at the rate of 1.5%par month until paid in full.WASTE KATFRIALS WHICH ARE WSCOVERED TO HE N[1N-17[1NFORNTING WILL BE SUVECT TO ADDITICINAL CHARGES. Ae," a rk", - 61- 27--16,1 Em TYPE 4R PRINT FULL-NAME 9TGNATURE DATIE I hereby certify that I have read and have rhe authority to bind the above tlsled goneralor to the terms found an bath the front and back at this form.State lbw requires that both the Genaralor and Transporter keep this form an file for a minimum DI(3y years.I hereby certify that all information In this and all attached documents contain true and accurate descripllons of the waste including that the waste is segregated and is not comingled with other waste streams.As the Generator.I acknowledge that aur site EPA ll)#is active_The waste stream listed above complies with the Waste Profile on record for the designated Facility.This document serves as written varinsatlon that the wasle siream(s)description and constituents found above are unchanged per the Facility Generator Waste Prattle Worksheet and also acts as the annual written verification for the Generalor Waste Profile Warkshaet of theso waste streams.I declare under penalty at perjury that the foregoing is true and correct. CleanTech Environmental Inc. � 5820 Martin Road s o Irwindale, CA 91706 5RIV R S -TYPE OR PRIM NAME ami EPA IQ #:CAL000330453 z cc Truck, Unit ID No. NATUREZ DATE The chocked box is the designated recycling facility ILIJ z } ❑Southwest Processors,Inc, D Lighting ResDurces 0 Vealia ES Technical ❑Heritage Enviornmeniai Oleantech Enviornpidrital 4120 Sandini Blvd. 905 East Francis Street Solutions LLC Services LLC 5870 Maltin Rd, Vernon,CA 90458 Ontario,CA 91761 1704 IN.1st Street 5520 Martin Rd. Iryfindale,CA 91706 cc W L)LX Ph#3231269-9876 EPA#CAROOD156125 Azusa,CA 91702 Irwindale,CA 91706 EPA#CAL000330453 CL = Ph#9091923-7252 EPA#CAD 008302903 EPA#CALD00330453 Ph#62fi1912-7200 Ph#6261334-5117 Ph#6261612-7200