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CleanT h SERVICE WORK ec � ORDER Environmental Inc. 5820 Martin Road ■ Irwindale, CA 91706 346433 Phone., 625-812-7200 WASTE RECYCLING RECEIP ° � r_-, Nameapegdc . Customer Purchase Order# Addressi 516 "Off Tlrive Safes Representative c--,Nl-i City, State, Zip:RIP01; CA r963-6-6 Phone#: _x„262 6375 EPA ID#: Federal Manifest#: Oa6a _�1 QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE GAL. USED OIL—NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 221 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 2 oo ' ) DRAINED USED OIL AND GAS FILTERS W L� m TOTAL WThe above used oil is °/Lubricating ail %Industrial oil � ACCOUNT STATUS: { J C.Q.D. { }OPEN ACCOUNT if open Account-payment is due net 30 days or a finance charge of 1.5% 0. per month will apply. GGENERATOR'S NOTIFICATION AND CERTIFICATION:Any used nil that the transporter receives from the generator will he transported to a certified used oil recycling facility that is U 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 OOT shipping name and are classilled,packaged,marked,and labeled and are in all aspects in proper condition for transport by a.01 m standards.All relevant information regarding known or suspected hazards assoclated with this waste has been disclosed.The costumer agrees to pay reasonable cast and attorney D tees incurred in the collection of this obligation.Venue for purposes of this obiigation shall by in Los Angeles County.I certify that the waste minimIzallon stalement Identified in 9O F CFR 25227(a)(I1 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 terms on this form both front and back.Signerguararttees the payment of CleanTech Invelces 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 he pald promptly.Prompt payment is definad 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 at the rate of 1.5%per month until pald in full.WASTE MATERIALS WHICH ARE DISCOVERED TO BE N0WCONFORMING WILL BE SUBJECT TO ADDITIONAL CHARGES. k.) ill;S jae,(L',,, TYPE 09 PRINT FULL NAME SIGNATUI E DATE I hereby certify that I have read and have the authority to hind the abova listed generator to the terms toond on bolh the front and hack of this form.Stale Law requires that bosh the Generator and Transporter keep this form on file for a minimum of(3)years.I hereby corlify that all information In this and all attached documenls Conlain true and accurate descriptions of the waste including that the waste is segregated and is not cont ingled wish 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 on record for the designated Fac 114.This document serves as written verfftcation that the waste streamts)description and consiRuants found above are unchanged per the Facility Generator Waste Profile Worksheet and also acts as the annual written verification for the Generator Waste Prallla Worksheet of these waste streams.I declare under penalty of perjdry that the foregoing is true and correct. iIx CleanTech Environmental Inc. 5820 Martin Road cc O Irwindale, CA 91706 W EPR I D #:CAL000330453DRIVERS NAME-TYPE OR PRINT FULL NAME a Truck, Unit ID No. rSIGNA URE DATE The checked box is the designated recycling facility w Z H 0 Southwest Processors,Inc, ElLighting Resources 11Veolia E5 Technical 0 Heritage Enviornmental TWCleantech Enviornmental U -j4120 Bandini Blvd. 845 East Francis Street Solutions LLC Services LLC 5820 Martin Rd. Vernon,CA 90058 Qntarlo,CA 91761 1704 W.1st Street 5820 Martin Rd. Irwindale,CA 91706 oc W 0 Ph#323/269-9876 EPA#CAR000156125 Azusa,CA 91702 Irwindale,CA 91706 EPA#CAL000330453 Ph#9091923-7252 EPA#CA0008302903 EPA#CAL000330453 Ph#6261812-7200 Ph#6261334-5117 Ph 9 626/812-7200