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== C =--1eanTech ORD SERVICE WORK ORDER Environmental Inc. 166774 2581 S. Sunland Ave. • Fresno, CA 91706 Phone: 800-531-9683 RT)" V Fg� n WASTE RECYCLING RECEIPT U- U Name: Customer Purchase Order# Address: Sales Representative City, State, Zip: Phone#: EPA ID #: Federal Manifest#: QUANTITY UNITS U.S.DOT DESCRIPTION CHARGE 1,4010GALUSED OIL—NON RCRA HAZARDOUS WASTE, LIQUID 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-- QGAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 LU DRUM(S) DRAINED USED OIL AND GAS FILTERS 2 LLL C7 m 11� TOTAL O Lu The above used all is °'o Lubricating oil %Industrial oil H W ACCOUNT STATUS: { y C.O.D. { I OPEN ACCOUNT if open Account-payment is due net 30 days or a finance charge of 1.5% 1 IL 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 oll recycling facility that is 0 lawfully operallng in accordance with a hazardous waste facililtes permit Issued pursuant to the Federal Act,I hereby declare that the contents of this consignment are fully and LU accurately described above by the proper DOT shipping name and are classilied,packaged,marked,and labeled and are in all aspects in proper condition far transport by 0.03.. M standards.All relevant inlormation regarding known or suspected hazards associated with this waste has been disclosed.The customer agrees to pay reasonable cost and attorney C fess Incurred in the collection of this obiigalinn.Venue for purpesos of lhk ohiloation shall he in Los Angeles County.I certify that the waste minimization statement identified in 40 F CFR 25227(a)(if I am a large quantity generator)or(b)Sit I am a small quantity generator)is true.I also acknowledge that I have read and agree to the terms on this Corm both front and hack.Signer guarantees the payment of CleanTech invoices in accordance with the standard terms of Net 30 days.It a Purchase Order is not issued,the employee authorizing the work performed guarantees that any invoices presented will be paid promptly.Prompt payment Is defined as payment in accordance with CleanTech standard terms of net 30 days. Invoice payment is not contingent upon payment by a third party.Interest on past due accounts will be charged ai the rate of 1.6%per month until paid in full.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON-GONFORM(NO WILL BE SUBJECT TO ADDITIONAL CHARGES. ;��N 0QS_gj4u:A, /I- TYPE OR PRINT FULL NAME SIGNATURE DATE I hereby cerllfy that I have read and have the authority to bind the above listed generator to the terms found on hoth the front and back of this form.Slate Law requires that both the Generator and Transporter keep this form on file for a minimum of(3)years.I hereby cerlily that all information in this and all attached documents contain true and accurate descriptions of the waste including that the waste is segregated and is not comingled with other waste streams.As the Generator,I acknowledge that oursite EPA to P is active.The waste stream listed above complies with the Waste Profile on record far the designated Facility.This document serves as wriRen verification Ihal the waste stream(s)description and constituents found above are unchanged per the Facility Generator Waste Prefile Worksheet and also acts as the annual written verification forthe Generator Waste Profile Worksheet of these waste streams.I declare under penalty of perjury that the foregoing is true and correct. CleanTech Environmental Inc, LU 2581 S.Sunland Ave. VAICr ❑ Fresno, CA 93725 04 EPA ID #:CAL00036$13 DRIV AME- iNT FULL NAME Z 1 ) a Truck, Unit ID No. Si DATE The checked box is the designated recycling facility ZV ❑❑,, LU Z H El Roadrunner Glycal,Inc. ❑Southwest Processors ❑Heritage Environmental Cleantech Environmental V ❑ 4636 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 5820 Martin Rd. V Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 cc U EPA#NVR000088427 EPA#CAL921646037 Coolidge,A7 85128 EPA#CALOU0330453 ILLIa X Ph 4 7021379-7179 Ph#80019170-3366 EPA#AZD081705402 Ph#6261812-7200 Ph#520/723-4167