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leanTe <br /> h SERVICE WORK <br /> �' ORDER <br /> Environmental Inc. 151967 <br /> 2581 S. Sun#and Ave. • Fresno, CA 93725 <br /> Phone: 840-531-98$3 <br /> WASTE RECYCLING RECEIPT <br /> Name: Customer Purchase Order <br /> Address: 11&14 Hniff Drive Service Technician H 1 i ,E <br /> City, State, Zip: Rnim CA 96366 Phone #: 563-262-63dh <br /> EPA ID it: CAL000308082 Federal Manifest #: <br /> QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE <br /> GAL USED OIL-NON RCRA HAZARDOUS WASTE, LIQUID -— <br /> CA WASTE CODE 221 <br /> GAL USED ANTI-FREEZE- NON RCRA HAZARDOUS WASTE, LIQUID <br /> cr CA WASTE CODE 134 <br /> OILY WATER FROM USED PARTS WASH SOLUTION -- <br /> GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 <br /> cc <br /> W <br /> W DRUM(S) DRAINED USED OIL AND GAS FILTERS <br /> ❑ <br /> In <br /> 0Get <br /> TOTAL <br /> 1. <br /> LU The above used oil is %Lubricating oil % Industrial oil <br /> d. ACCOUNT STATUS: ( }C.O-D. J OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% <br /> 0 per month will apply. <br /> 0 GENERATOR'S NOW ICATKIN AND CERTIFICAPON, Any used oil that the transporter receives from the generator will be transported to a certified used oil recycling facili- <br /> UJI ty that is lawfully operating in accordance with a,haiardeus waste facilities permit Issued pursuant to the Federal Act. I hereby declare final the contents of this consign- <br /> ment are fully and accurately described above 6j the proper shipping name and are classified,packaged,marked,and labeled and are in all respects in proper condition <br /> ❑ <br /> for transport by highway according to applicable national regulations. All relevant information regarding known or suspecfed hazards associated with this waste has been <br /> H 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 <br /> 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 <br /> above by the proper shipping name,and are classified,packaged,marked,and labelediplacard,and are in all respects in proper condition for transport according to appli- <br /> cable and national governmental regulations. If export shipment and I am the primary Exporter,I certify tat the Contents of this consignment conform to terms of the <br /> attached EPA Acknowledgment of Consent. I certify that the waste minimization statement Identified In 40 CFR 262.27(x) (if I am a large quantity generator)or(h)(if I <br /> am a small quantity generator)is true. I hereby certify that all information in this and all attached documents contain true and accurate descriptions of the waste. All rel- <br /> evant information regarding known or suspected hazards associated with the waste has been disclosed. I also acknowledge that I have rear)and agree to the terms on <br /> this form,both front and back. Signer guaranlees the payment CleanTech invoices in accordance with the standard terms of Net 30. if a purchase order is not issued, <br /> 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 <br /> 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 <br /> 1.5%per month until paid.WASTE MATERIALS WHICH ARE DISCOVERED TO BE HON-CONFORMING WILL BE Sl18JE TO ADDITIONAL CHARGES. <br /> TYPE OR PRINT FULL NAME SIGNATURE DATE <br /> I hereby certify that I have read and have the authority to bind the above listed generator to the terms on th verse side of this form. <br /> State Law requires that you keep this ReceiptfBill of Lading on file for no less than (3)years. <br /> GC Clean Tech Environmental Inc. <br /> Imo— 2581 S.Sunland Ave. <br /> 0 Fresno, CA 93725 ` <br /> (A EPA ID#:CAL000368136 f OR PRINT FU E <br /> cc Truck, Unit IC No. S! GATE <br /> The checked box is the designated recycling facility <br /> La z ❑ Roadrunner Glycol,Inc. ❑ Southwest Processors ❑ Heritage Environmental jeantech Environmental <br /> v 4636 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 5820 Martin Rd. <br /> 3 y fi Las Vegas,AIV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91746 <br /> = W EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 <br /> CIL cc Ph#7021379-7179 Ph #8001900-3366 EPA#AZD081705402 PH 1626/812-7200 <br /> Ph#5201723-4167 <br />