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`_` C1e a n Te ch =- SERVICE WORK ORDER Environmental Inca 151966 2581 S. Sunland Ave. e Fresno, CA 93725 , _ - Phone: 830-531-9683 - I WASTE RECYCLING RECEIPT -- Name: a Customer Purchase Order# Address: -!,,I--S Hoff 11 ayt, �y Service Technician Hrse_1 F City, State, Zip: Ripen CA 963& Phone #: X63-262-5376 EPA ID #: CAL00 08t 8'— _ Federal Manifest#: c '7 73 QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE OM GAL USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 221 0 GAL USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID pc CA WASTE CODE 134 0 OILY WATER FROM USED PARTS WASH SOLUTION– � GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 W Z DRUM(S) DRAINED USED OIL AND GAS FILTERS LIQ m ❑ ; ! G is TOTAL LU w F- J The above used oil ig %Lubricating ail % Industrial oil C- ACCOUNT STATUS: ( }C.C.D. ( )OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% 0 per month will apply. U GENERATOR'S NOTIFIFATICN AMC CERTIFICATION; Any used oil that the transporter receives from the generator will be transported to a certified used oil racycling facAi- W ty that is lawfully operating in accordance with a hazardous waste facilities permil issued pursuant to the Federal Act. I hereby declare that the contents of this consign- or mens 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 4 for transport by highway according to applicable national regulations. All relavant information regarding known orsuspected hazards associated wilh 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 obligation shall be in Los Angeles County. I declare ander 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 labaiedipiacard,and are In all respects in proper condition for transport according to appli- cabJe and national governmental regulations. If export shipment and I am the primary Exporter,J certify that the contents of this consignment eonlorm to terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 GFR 262.27(a) (it I am a large quantity generator)or(b)(it I am a small quantity generator)Is true. I hereby certify that all Jnlofmativn 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,both trout and back. Signer guarantees the payment CieanTech invoices in accordance with the standard terms of Net 30. If a purohasa 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 he charged at the rate of 1.50/6 per nth until paid.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NDN-CONFORMt WILL BE SUBdEC TO ADDITIONAL CHARGES. TYPE❑ RINT FULL NAME SIGN URE DATE 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 farm. Stele Law requires that you keep this ReceiptiBill of Lading on file for no less than(3)years. a Clean Tech Environmental Inc. UU 2581 S.Sunland Ave. ❑ Fresno, CA 93725 W EPA ID#:CAL000368TYP R PRINT a: Truck, Unit ID No. `1�36 7 70 SIGNATURE �~ DATE The checked box is the designated recycling Facility UJ Z > ❑ Roadrunner Glycol,Inc. © Southwest Processors E)Heritage Environmentalleantech Environmental U � 4636 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 5820 Martin Rd. > Las Vegas, NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 cc w LL EPA#NVR000fl88427 EPA#CAIL921646037 Coolidge,AZ 85128 EPA#CALC00330453 UL!a cc Ph#742/379-7179 Ph#8401940-3365 FPA#AZD081705402 PH#6261812.7200 Ph#5241723-4167