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ieanTech SERVICE WORK ORDER Environmental Inc. 164535 2581 S. Sunland Ave. • Fresno, CA 91706 Phone: 800-531-9683 PDJ90T"�n WASTERECYCLING S RECEIPT Name: ;�,brarafic;t_- Customer Purchase Order# Address:1.515 Hi)ff Drive Sales Representative 8nj t.F _ City, State, Zip: Pl1par frit 95,�ta Phone#: "�-;_:Y'r=_ I r EPA ID #: _ p.-41 jjnfjagU0&, Federal Manifest#: QUANTITY UNITS U.S.DOT DESCRIPTION CHARGE GAL. USED OIL—AVON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 221 GAL. USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE, LIQUID r CA WASTE CODE 134 OILY WATER FROM USED PARTS WASH SOLUTION— GAL. NON-RCRA HAZARDOUS WASTE, LIOUID. CA WASTE CODE 134 W DRUM(S) DRAINED USED OIL AND GAS FILTERS Z LU 0 r m Q� U> L' TOTAL Thea ove used oil is %Lubricating oil %Industrial oil J ACCOUNT STATUS: { j C.O.C. { ]OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% Il per month will apply. DGENERATOR'S NOTIFICATION AND CERTIFICATION:Any used oil that the transporter receives from the generator will he transported to a certilled used oil 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 LU accurately described above by the proper DOT shipping name and are classified,packaged,marked,and labeled and are in all aspects In proper condilim for transport by DAT W 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 0 tees incurred In the collection of IhI*,obligation.venue fpr purposes at this obligation shall be in Los Angeles County_I certify that the waste minimization statement identified In 40 I. CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true.I also acknowledge that I have read and agree to the termsm this farm both front and back.signer guaranlees the payment of CleanTuch Invoices in accordance with the standard terms of Net 30 days.If 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 3e 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°1 per month untll paid in full.WASTE MATERIALS WHICH ARE DISCOVERED To BE NON-C0NFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. 11�'Q4f • i f'�3Q r TYPE OR PRINT FULL NAME SIGNATU DATE I hereby certify that I have read and have the authority to bind the above listed generatora terms found nth the front and back of this farm.Slate Law requires that both the Generator and Transporter keep this form an file for a minimum of(3)years.I hereby cerTy that all I-'' atlon 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 aursile EPA ID k is active.The waste stream listed above complies Min the Waste Profile on record for the designated Facility.-Mis document serves as written verification that the waste stream(s)description and constituents round above are unchanged per lite Facility Generator Waste Profile Worksheel and also acts as the annual written veilticalron for the Generator Waste Profile Worksheel at these waste streams.I declare under penalty of perjury that the foregoing is true and correct. CC CleanTech Environmental Inc. LU 2581 S. Sunland Ave. 0 Fresno, CA 93725 aj EPA I D #:CALDOd3fi8136 DRIVER' AME-TYPE ORP FULL NAME Z � ,rte Truck, Unit ID No. �"" SIGNAT DATE ❑ The checked box is the designated recycling facility W Z >' E Roadrunner Glycol, Inc. E]Southwest Processors ©Heritage Environmental Cleantech Environmental 4636 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 5824 Mallin Rd. w Las Vegas,NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CAL000330453 Lu CL cc Ph#7021379-7179 Ph#8001900-3366 EPA#AZDO81705402 Ph#6261812-7200 Ph#520!723-4157