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Cl nT SERVtCE WORK'+ a ORDER Environmental Inc. 151963 2581 S. Sunland Ave. e Fresno, CA 93725 Phone: 800-531-9683 i rr - 1 WASTE RECYCLING RECEIPT Name: Customer Purchase Order # Address. i�i F, gaff nri-ur,, Service Technician H01 ISF City, State, zip: piri Phone #: 3-262-63_ EPA ID #; C-ALOCK1308082 Federal Manifest #: QUANTITY UNITS U.S.DOT DESCRIPTION CHARGE GAL USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID — CA WASTE CODE 221 GAL USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION — GAL. NDN-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 Z DRUM(S) DRAINED USED OIL AND GAS FILTERS Lu C3 pa r W ky oQ TOTAL f— J The above used oil is Lubricating oil %Industrial oil d ACCOUNT STATUS: ( }C.O.D. { 7 OPEN ACCOUNT If open Account-payment Is due net 34 days or a finance charge of 11.5% 0 per month will apply. GENERATOR'S NOTIFICATION AND CERTIFICATION; Any used oil that the transporter receives from the generator will be transported to a codified used oil recycling facili- LI 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 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 highway according to applicable national regulations. All relevant information regarding known or suspected hazards associated with this waste has!Seen Irl disclosed. The customer agrees to pay reasonable cost and attorney fees incurred in the collection of[his obligation. Venue for purposes at this obligation 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 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 fortranspon according to appli- 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, I certify that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity generator)or(b) (if I am a small quantity generator)is true. I hereby certify that all Information in this and all attached documents caniafrn true and accurate descriptions of the waste. Ali rel- evani 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%P r month until paid.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NUN-CONFDRMING WILL BE Sl1BJECTTO ADDITIONAL CHARGES. TYPE OR PRINT FULL NAME SIGNATURE UA—TE-- I heredy certify that I have read and have the authority to bind the above listed generator to the terms❑ ,the reverse side of Iris lorm. Slate Law requires Shat you keep this Heceipt!Bill of Lading on file for no less than(3)years. cc Clean Tech Environmental Inc. 2581 S. Sunland Ave. cc 0 Fresno, CA 93725 ZTY OR NT AME fn EPA ID#:CAL000368136 a 9/�o Cr Truck, Unit ID Na. SIGNAT E DATE The checked box is the designated recycling facility w ZZ ❑ Roadrunner Mycol, Inc. © Southwest Processors ❑ Heritage Environmentalleantech Environmental 4636 Industrial Center Dr, 4120 Banding Blvd. Services LLC K51820 Martin Rd. ty Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 EPA#NVROOD088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 UJ UJ LL Ph#7021379-7179 Ph#8001900-3366 EPA 9 AZD081705402 PH#6M81 2-7200 Ph#5201723-4167