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teanTech SERVICE =-- C � WORK OF-DER Environmental Inc. 166772 2581 S. Sunland Ave. • Fresno, CA 91708 Phone: 800-531-9683 �- WASTE RECYCLING RECEIPT Name: Customer Purchase Order # Address: Safes Representative City, State,Zip: Phone#: EPA ID #: Federal Manifest QUANTITY UNITS U.S.DDT DESCRIPTION CHARGE USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID GAL. CA WASTE CODE 221 f GAL. USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION — aGAL' NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 cc LU DRUMS) DRAINED USED OIL AND GAS FILTERS 2 LU W . �Q e, TQ7AL v O W The ove used oil is 96 Lubricating oil %Industrial oil H J ACCOUNT STATUS: ( )C.C.D. J OPEN ACCOUNT If open Account-payment Is due net 30 days or a finance charge of 1.5% R per month will apply. pGENERATOR'S NOTIFICATION AND CERTIFICATION:Any used all Thal the transporter receives from the generator will be transported to a certilied used oil recycling facility that is a lawfully operating in accurdance with a hazardous waste facilities permit issued pursuant to the Federal Act. I heraby declare that the Contents of this consignment are fully and LV accurately described above by the proper DOT shipping name and are classified,packaged,marked,and laMed and are In all aspects In proper condkiun for transport by a.D.T, M standards.All relevant Informallon ragarding known or suspected hazards associated with this waste has been disclosed_The custarnar agrees Eo pay teasunable cost and attorney 0 tees Incurred In the co3lecflon of this obligation.Venue for purposes of this obligation shall be in los Angeles County.I certiff,That the waste minimization slatement-identified In AO CFR 25227(a)[if I am a large quantity generalor)or(b)(if I am a small quantity generatory is true.I also acknowledge that I have read and agree to the termsan this form both front and back.Signer guarantees the payment of CleanTech invoices in accordance with the standard terms of Nel 30 days.If a Purchase Order is net issued,l4employee authorizing the work performed guarantees that any invoices presented will be paid promptly.Prompt payment is defined as payment in accordance with GleanTech standard terms of net 30 days. Invoice payment is not contingent upon payment by a third party.Interest on pall due accounts will be charged at the rate of 1.5%per month until paid In full.WASTE MATERIALS WHICH ARE DISCOVERW TO BE NDN-COMFORMING WILL BE$ABJECT TID ADOrrIDNAL CHARGEES. _ -ze I 1 Vint O iNT E LL NA-ME NATURE DATE I hereby certify that I have read and have the authortty to hind the above listed generator to the terms found on bath the front and back of this farm.Slate Lew r8puire5 that both the Generator and Transporter keep this form on file for a minimum of(3)years.I hereby certity that all information in this and all attached documents contain true and accurate descriptions of the waste Including thal the waste Is segregated and is not comingled with otherwaste streams_As the Generator.I acknowledge that our silo EPA I0#is active.The waste stream listed above complies with the Waste Profile on record for the designated Facillty.This document serves as written verification that the waste sireamist description and consfituents lound above are unchanged per the Facility Gansralor Waste Pronto Warkshaef and also arAs as the annual written veriffeatlan lorlhe Generator Waste Profile Worksheet of these tussle streams.I declare Nader penalty of perjury that the foregoing is true and correct. CleanTech Environmental Inc. 2581 S. Sunland Ave.cc �� ' ❑ Fresno, CA 93725 DRIVER'S N -TYPE OR FULL NAME to EPA ID #:CAL000368136 ff � f F_ Truck, Unit ID No. SIGN RE DATE The checked box Is the design ed recycling facility w El Roadrunner Glycol, Inc. ©Southwest Processors ❑Heritage Envirorlmentai Cleantech Environmental 4636 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 5820 Martin 8d, r U Las Vegas, NV 89115 Vemon,CA 90058 284 East Storey Road Irwindale,CA 91706 cc 0 a EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 W cc LL Ph#7021379-7179 Ph#8001900-3365 EPA#AZDO817G5402 Ph#8261812-7200 Ph#5201723-4167