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FOR SERVI6E CALL: SERVICE ORDER FORM NO.WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-800-727-2879 <br /> 3037759 <br /> FOR ACNG CALL: worZLD p1L <br /> 562-231-1550-1550 <br /> ENVIRONMENTAL SERVICES. RECEIVED BY SJCEHD: <br /> s 7300 CHEVRON WAY,DIXON;CA 95620 11/08/2019 <br /> " DEL MONTE FQODS:pC#48 :1-800-727-2879.. ; <br /> P PO NESTLE WAY www.woRLDOILcoRP cOM • > Aw BOX 69857Q <br /> E TRANSPORTER EPA'#CAD028277036'"�' <br /> LATHROP, CA 95330 SAN ANTONIO. 'rX 78269-8570 <br /> 0 (209) 813-9941 (209) 513-9941 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DEL642 R CUTE 124 Istantm <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 10/212019 irAL000304826 V I <br /> PART# DESCRIPTION QTY UNIT:PRICE QTY P/U TOTAL <br /> WOSC USED OIL SERVICE QHARGE .:.,� �� - .. 1 $85.00 $85.00 <br /> wo USED OIL/MIXED OILS ,�-.��.. •,..,.• •.:..,.r,. ,,x y,.-,.rw t r.si. 30 $0.00 $0.00 <br /> • 4!T�ILL.f k !✓Ix�•' Y•„7:1:1.}./�r:.rVli Jel�. - <br /> Y.KIi�mf5np.rn.•r ni:.;,x..•.ryd,,,,n%Y]I,.., <br /> . I •.r.,i:r-l�:n 4di.vr!.sr�.1-I•'+7r�?I.rtr•+�neV?+� <br /> ' - •+ry.•_rry'I' •u,�1 ryu,w'7.A�,�'aiJrp .vtm.a�n:. <br /> ALT M5387 RATCfi 0 rdw.•All. f ltw*6_Em""h <br /> TOTAL <br /> CASH REC'D: CHECK# 3 <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXEDOILS) . STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE;LIQUID(ETHYLENE%YCOC SOLUTIONS). STATE CODE - <br /> OTHER: <br /> CES-CERE3, 194 MORGMAU_,CERE-�i,CA <br /> DESIGNATED TSDF: AL Ir i <br /> ALTERNkTE TSDF•. . <br /> El <br /> arca'_ osis: T <br /> DRUMS P/U: EMPTY DRUMS: FACILITY-_- BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX), <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> �(s1)I have not mixed any of the wasta described above W411 any Other I'+azsrd0us yraate,Iba total,hailda content is LESS Chart U00 ppm,and the woste does na!contaln any PCBs.I have <br /> compiled with the requirements of the applicable California used oil managemani regulations to dalrumina this Is true.I agree to accept the additional chnrges for the disposal of this waste if <br /> the Information I have provided about this waste Is incorrect . ­ <br /> Q0 <br /> #2]have not mixed any of the waste described above With any other hazardous waste,the total halide content is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional <br /> charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect <br /> p 03)This waste is from a tank which collects waste oil from household"do-it•yoursett"(DIY)andlor conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil eontalhed in my DIY/CESO.G collection tank Is sofay from PIY and/or CESOG sources.I hzvc not mixed this waste oil with any other hazardous waste or waste oil <br /> from other sources.I agnm to accept the additional charges for disposal at this waste N the Information I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text <br /> ,certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the <br /> practicable method or treatment,storage,or disposal currently available tome which minimizes the present and future threat to human life and the environment. <br /> This individual signing in the space set forth below on beWl of costonner represents and warrants that he/she has the authority to bind customer,that the forgoing descriptions of waste <br /> and materiels are true and accurate as packaged,marked,and fsbefed,are ready for transportatlon In accordance with applicable state and federal regulationsT and that customer shall abide <br /> by the Standard Terms and Condit lons on the reverr•e side of this Service Order. <br /> Service Orders with an am"cisted hpTardous waste manifest(either site specific or consolidated)are subject to nEPA Fee. ese fees cover the EPA pass-through fee and administration <br /> of Ihe-ahM1nnifest program, These feea vary based on Manifest type. Applicable fees will appear on your billing invoice. /07" <br /> I I C <br /> Customer Signatur Date Driv gnature Date <br /> nt Name Print Driver Name <br />