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CleanTech SERVICE == WORK ORDER Environmental Inc. 2581 S.Sunland Ave. • Fresno, CA 93725 Phone:8001-531-9883 WASTE RECYCLING RECEIPT Name: Customer Purchase Order# Address: r-a:i. Service Technician Hf-11 i-I;F City, State, Zip: _V'rsif�al_L't; Phone #: 6 63-2 162_ EPA ID #:_ i '. P _ah ��t= � Federal Manifest #: r -1 QUANTITY UNITS U.S. DOT DESCRIPTION CHAR CAL USED OIL–NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE COLE 221 � CAL USED ANT!-FREEZE-- NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 0 OILY WATER FROM USED PARTS WASH SOLUTION – Q GAL, NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 cc W Z DRUM(S) DRAINED USED OIL AND CAS FILTERS L3 M C 0 G& TOTAL W t— LU The above used oil is 014 Lubricating atf %Industrial oil 0. ACCOUNT STATUS: C.Q.O. i OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% Q per month will apply. 0 GENERATOR'S NOTIFICATION AND CERTIFICATION: Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling facili- mty that is lawidly operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act. I hereby declare that IN contents of this consign- ment are luny and accurately described above by the proper shipping name and are classified,packaged,marked,and labeled and are in all respects in proper condition ❑ for transport by highway according In applicable national regulations- All relevant Information regarding known or suspected hazards associated with this waste has been h disclosed. The customer agrees to pay reasonable cost and attorney fees incurred in the collection of this obligation. Venue tar purposes of 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 fullyandaccurately described above by the proper shipping name,and are classified,packaged,marked,and Iabeledlpiacard,and are in all respects in proper condition for lranspartaccording to appli- cable and national governmental regulations. If export shipment and I 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 minimizatlon statement identified in 40 CFR 262-27(a)(it I am a large quanlily generator)or(b)(If I am a small quantity generator)is true. I hereby certify that all information in this and all attached documents contain true and accurate descriplionsof 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 back. Signer guarantees the payment CleanTech invoices in accordance with the standard terms-of Nei 30. It a purchase order is not issued, the employee authorizing the work to be performed guarantees that any invoices presented will be paid promptly. Promp(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. Inter tan past doe accounts will be charged a1 the rate of 1.5%per month until paid.WASTE�MATERIALS WHICH ARE DISCOVERED TO BE HON-CDNFORIMiNG WILL f €Ef-TO-ABUITIONAL CHARGES. �h: - TYPE OR PRINT FULL NAME -Sl A DATE I hereby certify that I have read and have the authority to bind theeaNs�qdlgenemator to the terms an the reverse side of this form. State Law requires that you keep Ihis Recelpt/Bill of Lading an fifess than(3)years. Clean Tech Environmental Inc. LU 2581 S. Sunland Ave. ❑ Fresno,CA 93725 W EPA ID#: CAL000368136 TYP IVT FUL ME Z a Truck, Unit IQ Na 1. SIONATURV DATE The checked box is the designated recycling facility LU 2 } ❑ Roadrunner Glycol,Inc. 0 Southwest Processors D Heritage Environmental /5C leartech Environmsrrtai U 4636 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 132 r Martin Rd. Las Vegas, NV 89315 Vernon,CA 80058 $4 East Storey Road Irwindale,CA 81706 W EPA#NVROOOOBB427 EPA#CAL921646037 Coolidge,AZ 85128 FPA#CAL000330453 aL. C Pli#7021379-7179 Ph#8041900-3366 EPA#AZD081705402 PH#626/812-7200 Ph#5201723-4167