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Oar <br /> RK <br /> SICE <br /> CleanTech EH ORD RDRK <br /> �M <br /> • Environmental Inc. 400251 L <br /> 5820 Marlin Road+ Irwindale, CA 91706 <br />' Phone:626-812-7200 <br /> WASTE RECYCLING RECEIPT <br /> Nam}#a Customer Purchase Order# <br /> Add rest 5 �— <br /> Sales Representative C� <br /> r <br /> City, Stale,Zip1 Phone#: w <br /> E=PA ID#: C-AL OQO 2 It { Federal Manifest#: e— <br /> QUANTITY UNIT <br /> DOT DESCRIPTION CHARGE <br /> GAD OIL-NON RCRA HAZARDOUS WASTE.LIQUID <br /> WASTE CODE 221 <br /> GAD ANT!-FREEZE-NON RCRA HAZARDOUS WASTE,LIQUID <br /> ASTE CODE 135 <br /> OILY WATER FROM USED PARTS WASH SOLUTION- <br /> GAL. NON-RCRA HAZARDOUS WASTE,LIQUID- CA WASTE CODE 134 <br /> W DRUM{S) DRAINED USED OIL AND GAS FILTERS E 141 V.t l b S -1 <br /> Uj <br /> TOTAL <br /> 'r" <br /> r� <br /> IaJ The above used oil is, %Lubricating oil_%Industrial oil 1.596 <br /> ACCOUNT STATUS I )C_0-1k t j OPEN ACCOUNT if open Account-payment Is due net 30 days or a finance eh4rgs of <br /> a. per month will apply. <br /> Thai <br /> 0 GENERATOR'S NDITFICATtON AND URTIRCATION:Arty used all Thal the transporter recervestrdrn the generator wlh hetrahSOFted Io aowihed used W amwling}acuity that rs }fu ky and <br /> U lawfully operating in accordance vnlh a haaardous waste taNknes perms,ssad pursuant;0 the Fedtrat All hereby deCiare that the egnlenls ql this etansbnmern are tiny and r tN D O.T <br /> W auuratery rlescneed appve by pie proper DOT sh ppinq name arid an class fled.pacAaged marked,and latteltd and ate m ITT aspects 0 propEr COdddioo for Ininspgn by D 0 T id anpmey <br /> m standards AI relevant irdon-ne w regardog known or suspected harards asstacraled wrlh this waste has been disNosed.The customer egress 10 pay roasonable Casr and attorney anted in 40 <br /> lKs Wrwrred tft the ColleitI qn of This o*Wion Venue for purposes of this 01119b ten ANTI be in Las Angeles County 1 Cettlfy that the,*gte mknahi aho,sUrement leerdmed rn 4g I both from <br /> F CFR 26227fa1 ill I am a Jarpe quantity generator!9r IL I(I t am a smaw gnanhty pentratori ra true.t also acknowledpa Ina;1 nave road and acres to fde terms on the form both front tonnrrg the <br /> ano back Signer ouararrees the payment of Cltanioch invoices in accerdance with The standard terms of Net 30 days It a Pmcrtaw Order is nil rss,, the emloyee p aulhortow me oillys <br /> work performed 9uaranTees Thal any rnydras preserved*lilt be p44 promplty Prgmpl payment is dehned as pii Jn xcarQrce Wdh CluoTech standard terms of net 3a days AATERULS <br /> Inyo.ce payment 15 nor contingent upon payment oy a third parry interest on past our a{tpUhts wiD ba charged at the rate oil 1$%pet month unto paid w fulr WASTE MATERLkt$ <br /> WHfCH ARE DISCOVERED TO BE NON-CONFOAMING WILL BE SUBJECT TO ADDITIONAL CHARGES, <br /> l inn •—. V L' <br /> TYPE OR PRINT FULL NA AE SIONATURE DATE as that kill <br /> t hereby carhily prat I have road and have try atJmOrr;y to God Ire above listed generator to me terms round on bath the hunt and back or Iles form Slate Law requires that bath yid accurate <br /> tits Generator and TrarlVertef kaep this form oh foe for a minimum of M years t hereby ctrtry that air mformahUn in this and all attaCW docurwis conlarr Tree and atturato s adrm The <br /> descupl ions of The wastt intludi ng TNT the waste q segrNaled and is not ComrhpTed with other vasle streams At IM Gtneralm,I asbywlrfdpa Iha}parsMe EPA la a to actkw.Tor description <br /> waSTe Stream hyted 3bavt cOrnpltea with the Wear!Prohk M fetOrd!Or the desrpnarrd fao�rdy Thta 40CUMEM SIMI as wuHee VIAACaROn That IM wsop ahaamla}1145alplto tarA Praia <br /> irkd conafiiuehk lowtd abova are mcltanpd pit the Factory Remoter Weefa Preto warkahen and 4180 acts as tk NMI wrlHen rarmcalton for the Gesaralor Walxt Preen <br /> WOraahaal et theta araalE alraatRa.1 dtckre under penatry 01 Penury Thal the fornioing is true and co(rect. <br /> itF <br /> nTech t=nvironmental Inc. <br /> V0 Martin Road Jf <br /> Ddale, CA 91706 D iJr �1_b Q�t) <br /> NEPA ID N:CA�000330453 DRIV NAME•TYPE OR PRINT FULL NAME <br /> a , oq <br /> k, Unit IC)No. <br /> S GNATURE DATE <br /> ecked box Is the designated recycling facility <br /> Walogy Vernon CR lighlinq Rasovrces 0 Patriot Waste Water ❑Iierita0e Emnommental CleanImestal <br /> .Boyle Ave. 8O5 East Francis Street 314 W.freedom Ave. 5ervict's LLG Marten Rd. rrjs <br /> Cn.CA 90058 Onlano,CA 91761 Orange.�A 92865284 East Storey Rd. IlVrindafe.CA9t7Ufi 0453 <br /> � L) W097030993 EPA#CAR000156125 Ph 18451 -4299 R24-Dispet�Clty Coolidge.AZ 85128 EA ff CALODO3.30453 40 <br /> 0. W0Ofi266.774T Ph 1909 923 7252 Ph 1714521 4545 EPA 1 A2{1fl81705402 Ph 1626'812 7200 <br /> Ph 15M3-4167 <br />