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..,_ � -- _ ._...r•r anti]�f► - ' i — SERVICE WORK Tech ORDER Environmental Inc. 198370 2581 S. Sunland Ave. a Fresno, CA 93725 r � � Phone:800-531-9683 WASTE RECYCLING RECEIPT f Name: Customer Purchase Order# '•' Address: C n Sales Representative ` City, State,Zip: r t r Phone#: EPA ID Federal Manifest#: ❑ Gr�lo �t/ r QUANTITY UNITS U.S.DOT DESCRIPTION CHARGE Cam:• - GAL. USED OIL—NON RCRA HAZARDOUS WASTE,LIQUID CA WASTE CODE 221 GAL USED ANTI-FREEZE—NON RCRA HAZARDOUS WASTE,LIQUID i CA WASTE CODE 134 cc OILY WATER FROM USED PARTS WASH SOLUTION— C.: D GAL. NON-RCRA HAZARDOUS WASTE,LIQUID. CA WASTE COME:134 � l LU Al LU DRUM(S) DRAINED USED OIL AND GAS FILTERS n W } W TQTAL , i} C LLUThe above used oil is %Lubricating oil %Industrial oil L7 i— �} W ACCOUNT STATUS: ( ]C.O.D. l 1 OPEN ACCOUNT It open Account-payment Is due net 3,0 days or o finance Charge of 1.5% Roil [� OIL per month will apply, DGENERATOR'S NOTIFICATION AND CERTIFICATION:Wry used nil that the transposer recelvea from the generator will be Iransponed to a terrified usedoil recycling ladllty that is C1 lawfully operating in accordance with a haNrdous waste facilllles parmil issued pursuant to the Federal Act.I hereby declare that the wf4errls oi this consignment are luny and accurately ds%rlwo above by the proper DOT Shipping name and are classdr@d,packaged,marked,an cts in proper condrtion for transport labeled and are in all aspe m standards.Air relevant information regarding known or suspected hazards assoolated with this waste has been disclosed.The CuslDmeT agrees to pay masanaale cast and attorney '• fees incurred in the CDII@CtiOn of this obligation.Venue for purposes of Ihis obligation shall be In Los Angeles County.I earthy that the waste rrdniml3aiion statamem idonlihed rn 4,0 CPR 28227;a}(if I am a large quantity generator)or(b)Elf I am a small'quantity generalor)Is true.I also acknowledge that I have Toad and agree to the terms on this form Min front and back.Signer guarantees the payment of Cleaniech Invoices In accordance vnth the standard terms Dl No!30 days.If a Purchase order is riot Issued,the employee authorizing the work performed guaramees Ihat any invoices presented will De pald promptly.Prompt payment Is defined as payment in accordance vrhh CleanTech standard terms of net 30 days. Invoice payment rs not contingent upon payment by a third party.w6rest on past due accounts will be Charged at the rele of 1.5%DOT month Until Mid in full.WASTE 1AATERIALS i WHICH ARE DISCOVERED 70 BE NOWCONFORMING WILL BE SU&JECT TO ADDITIONAL CHARGES. TYPE OR PRINT Pt1LL NAME7 SIGNATURE � _• I hereby cerlity that I NO read and have the alltbDriiy to bind the above listed generator Iq the terms found Dn both the frgmt and back of this farts,Stale Law requires that win the Generator and Transporter keep this form On file for a minimum of(3i yearn I hereby cartity that all information in this and all attached documents contain true and aCCurate . descrrplions off"waste including that the waste is segregated and is not cominpled with other waste Streams.As the Generator,I acknowledge that our Site EPA ID 1 is active.The • waste strOant listed above oomplies with the Waste Profile an record Tor the designated Facility.Tkls document serves as wrtaan vaH kptlgh that the wish steam(s)description and CDosillaords found above are unchanged per the Facility Generator Waste Profile Worksheel and also ads as Ina anaial written verificaulan for the Generator Wade Fronts r Workshaat oI that@ ieasle streams.I declare under penalty di perjury that the TO100irig is true and correct - CleanTech Environmental Inc. ' r 2581 S.Sunland Ave, C a Fresno, CA 93725 DRIVER'S NAME•TYPE PRINT FULL NAME EPA ID*:CAL000368136 z IM Truck, Unit ID No. SIG V URE DAT The checked box Is the designated recycling facikity � Envi r3k>_ �• . ❑Roadrunner Glycol,Inc. ❑Southwest PrDDessors ❑Heritage Environmental ❑Clttantech ronmental 4fi36 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 5820 A+lartin Rd. Las Vegas,ITV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91706 c Q W EPA#NYRODD089427 EPA#CAL9211 ppQ 46037 Coolidge,AZ 85128 EPA#CALM53 LU Ph 4 702/379-7179 Ph 1800190M366 EPA#AZD081705402 Ph#62012-72fl0 Ph#520f723-4167