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SERVICE WORK CleanTech ORDER Environmental Inc. 166770 2581 S.Sunland Ave. • Fresno, CA 91705 Phone: 804-531-9883 WASTE RECYCLING RECEIPT P `r r-77 Name: Customer Purchase Orders# _ `y Address: Sales Representative City, State, Zip: Phone #: EPA M #: Federal Manifest#: gaJ QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE GAL USED OIL—NON RCRA HAZARDOUS WASTE:, L#QUID CA WASTE CODE 221 GAL USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 O GAL QTLY WATER FROM USED PARTS WASH SOLUTION — NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 LU DRUM(S) DRAINED USED OIL AND GAS FILTERS f W rT'L7 7• - GTOTAL H The above used oil is °I°Lubricating oil %industrial all J ACCOUNT STATUS: { )C.O.Q. ( }OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1,5% CIL per month will apply, QGENEAATOR'S NOTIFICATION AND CERTIFICATION.Any used oil that the transporter receives from the generator will be transported to a certifled used oil recycling tacillty that is 0 lawfully operating in accordance with a hazardous waste facilities permit Issued pursuant to the federal Act.I hereby declare that the o0nlenls of this cunsignmmi.are fully and W accurately described above by the proper DOT shipping name and are otassitled,packaged,marked,and labeled and are in all aspects in proper condilbrt for transport by D.D.T. M standards.All relevant information regarding known or suspected hazards associated with this waste has been disclosed.The customer agrees to pay reasonable cost and attorney ❑ fees Incurred in the colleetian of this obligation-Venue for purposes of this obligation shall be In Las Angeles County.I certify that the tvaste minimiatienslatement IdentillW In 40 �. CFR 26227(a)(it S am a large quantity generator)or(b)(if I am a small quantity generalor)is true.I also acknowledge that I have read and agree to the IermSofl this farm both front and back.Signer guarantees the paymentof CleanTech invoices In accordance with the standard terms of Nit 3D days.It a Purchase Ordar is not Issued,theemployee aulhorizing the work perforrned guarantees that any Invoices presented will ba paid promptly.Prompt payment is defined as payment In accordance with CleanTech 51andard lerms of net 30 days. { Invoice payment is not ccnlingmt upon payment by a third party.Interest on past due accounts will be charged at the rale of 1.510 per month until paid In full.WASTE MATERIALS • WHICH ARE:DISCOVERED TO BE NDN-CONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. TYPE OR PRINT FULL NAME SIGNATURE DATE I hereby cerllty that I have read and have the authority to bind the above listed generator to the terms found on both the front and back Of this farm.Slate Law requires that both She Generator and Transporter keep this form on file for a minimum of(3)years.I hereby certify that all informalion in this and all attached documents contain true and accurate descriptions of the wasle including that the waste is segregated and is not comingled with other waste streams.As the Generator,I acknowledge that our site EPA ID#is active-The waste stream listed above complies with the Waste Profile oo record for the designated Facllity.This document serves as written verification that the waste stream(s)description andleatlstiluanis l0und above are unchanged per the Facility Generator Waste Pronle Worksheel and 3150 acts as the annual wrttlen verilivatlon tar the GeneratorWasle Profile Worksheet of these waste streams.I declare under penalty of perjury that the taregoing Is true:and correct. CleanTech Environmental Inc. ILI 2581 S. Sunland Ave. 1 //A 4 Fresno, CA 93725 "s 11 EPA ID#:CALf8QC368136 EPA ME-TYPE OR 1 LL NAME cc z Truck, Llrtit I No- SIGNATU DATE C1 (5 The checked box is the designated recycling facility 411, Lu z H I]Roadrunner Glycol, Inc, ❑Southwest Processors ❑Haritage EnvironmentalC leantech Environmental v a 4636 Industrial Certter Or, 4120 BandW Blvd. Services LLC / `5828 Martin Rd, > v Las Vegas, NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 ot W L EPA#NVR000098427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 IL Ir Ph#7021379.2179 Ph 0 8001900-3366 EPA#A7Q081705402 Ph#626181.2-7200 Ph#5201723-4167