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== C ==1eanTech SERVICE WORK ORDER Environmental Inc4 156775 2581 S. Sunland Ave, • Fresno, CA 91706 Phone: 800-531-9683 _ WASTE RECYCLING RECEIPT Name: _ ----- --Y� Customer Purchase Order# Address: Sales Representative City, State, Zip: Phone#: EPA ID #: Federal Manifest#: QUANTITY UNITS U.S.DOT DESCRIPTION CHARGE rtrt�� GAL. USED 01-NON RC RA HAZARDOUS WASTE,LIQUID 1 CA WASTE CODE 221 GAL. USED ANTI-FREEZE-NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION- 4 GAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 UI DRUM(S) DRAINED USED OIL AND GAS FILTERS Z w 0 to c C TOTAL f] The ab ve used ail is %Lubricating ail %Industrial nil W ACCOUNT STATUS: J C.O.D. { J OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% CL 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 cerlifled used oll recycling facility that is 0 lawfully operating in accordance with a hazardous waste facilities permit issued pursuant to the Federal Act.I hereby declare that the contents of this consignment are fully and lL accurately described above by the proper DOT shipping name and are classified,packaged,marked,and labeled and are In all aspects in proper Condition lot transport by D.O.T, CID standards.All relevant intormation regarding known or suspected hazards associated with(his waste has been disclosed.The customer agrees to pay reasonable cost and attorney Q, tees incurred in the collectlon of this obligation.Ventie for purposes of this gbllpatlnn shall he in Los Angeles County.I certify that the waste minimizallon statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a small quantity generatory is true.I also acknowledge that I have read and agree to the lerms on this form bath front and back.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 lerms of net 3Q days. Invoice payment is not contingent upon payment by a third party.Interest on past due accounts will be charged at the rate of 1.5%per month until paid In full.WASTE MATERIALS WHICH ARE DISCOVERED TO BE NON-CONFORMING WILL BE SUBJECT TO ADDFTIONAL CHARGES. TYPE OR PRINT FULL,NAME IGNATURE pqT I hereby certify that I have read and have the authorily to bind.ihe above listed generator to a terms found on he front and back of Ihis form.State Law requires that both the Generator and Transporter keep this form an lite for a minimum of(3)years.I hereby Cerlify that all infor tion in this and all attached documents contain true and accurate descriptlons of the waste Ino too Ing that the waste Is sepregated and is not ccmingled with other waste 51f ea .As the Generator,I acknowledge that our site EPA ID r is active.The waste stream listed above complies with the Waste Profite on retard for the designated Feel lity.This document serves as w4fieo verilica tion I h a t the waste siream(s)descripiIan and constituents sound above are unchanged per the Facility Generator Waste Profile Worksheet and also acts as the annual written verificallon for the Generator Waste Profile Worksheet of these waste streams.I declare under pen^,of periury that The foregoing is true and correct. Ir CleanTech Environmental Inc, 2581 S. Sunland Ave.cc �- p Fresno, CA 93725 CLU) EPA 0 #: CAL00036 Z 813 DRI ER' INE-TYPE f] FULL NAME a Truck, Unit f❑ No. SIGNA DATE The checked box is the designated recycling facility h [3 Roadrunner Glycal, Inc. ❑Southwest Processors El Heritage EnvironmentalCleantech Environmental v Zi 4636 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 5820 Martin Rd. Com] Q Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 ILL! W EPA#NVR000088427 EPA#CAL921646037 Coolidge,A2 85128 EPA#CAL000330453 a Ph#702/379-7179 Ph#8001900-3366 EPA#AZOD81705402 Ph#6281812-7200 Ph#5201723-4167