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Wol rk Order <br /> t� 1210 Elko Drive 2010 Mission Rood 265 Riggs Avenue 13722 Cormenito Road 6137 Edith Blvd.NE 511 Highway 213 Work Order# <br /> Sunnyvale,(A 94089 Escopdido,CA 92029 Mei(ed,(A 95341 Santa fe Springs,(A 90670 Albuquerque,NM 87107 Chaparral,NM 88081 Proposal# 88838 A <br /> ACT 408 548-5050 P 760 489.5600 P 209 722-4228 P 714 545-2191 P 505 349-5250 P 575 824-0164 P Date <br /> 408 548.5052 F 760 489.5625 F 209 722.8228 F 714 545.2287 F S05 344-7986 F 575 824-0208 F Acct.sales Manager <br /> Customer Information Service Request " <br /> Name: W a Ptikitillililtf FomW LLC Stock m <br /> Address: i pin&l Dt Description: .......................................... .............................................. ... <br /> CA 8s= ...... ..... ..................................... ....................................... ..... <br /> ............ <br /> ....... <br /> .... <br /> ......_...... <br /> EPA ID# CAL000364M .................................................. <br /> ..............._..._...................................................................................................................................._.................................. <br /> ...._................._... <br /> Main Contact: Biih�A ttln I-56-0M-ABSORBENT AND OIL-ACT47257 <br /> C..�.30 DIGi-Vfih�31'E MrtiC Ai1C:T•11288_.._..._................................._......................................................................................... <br /> Phone: <br /> . .... .., . <br /> ......1.__30.!! +1.=. : 't�1C�;1 ..47. 29........................................................................................._...................................................... <br /> ..... <br /> Secondary Contact: 1- -CF-4Fr FLUORESCENT TUBES-ACT2744 <br /> Phone: t-.$.._flF',wfWrBULft'i 11[:WO......................_.............................................................. <br /> PO# `l. G�011:23 -7 Ca t-5-DF-NON-PCBBN.LAST8-ACM48 <br /> 1..--EA-.55.Ce{tori.laaon..........._......_._........:..................._......._._.............:............................_..................._....................................__ <br /> Materials and Equipment 2-5-DF-UIIIlt7ERSAI.AEl�OS-Ctf441869 <br /> New Reconditioned 1. t o'yi....UN. .1AZ. -.�i..T0p.................................................................. <br /> Supplies 2-EA-80 Gtslion tilieW Drum- N1A2-Open Top <br /> Metal Poly Fiber Metal Poly Fiber <br /> 85-gallon overpack _ { Gfl l ►Df(Mri..._ ............................................................................................................................ <br /> ............._....................._ ._................ ...................>................... <br /> 55-gallon closed top _EA-pWOMM Pi+bfedw EWWipmeM-Level D <br /> 55-gallon open top *AW __.......................................................................... <br /> .....................................»..........._...... ._................. <br /> 30-gallon closed top t-EA-F081 S EMrgyResxrvtetyFes-8'K <br /> ........_......... ...................;............................................................_................. <br /> ....................... <br /> 30-gallon open top w <br /> .........................._............ <br /> ................................. <br /> ..... <br /> 20-gallon closed top 1 Services <br /> K 20-gallon open top <br /> i..._.......... ........._ Disposal Services: <br /> 15-gallon closed top Quantity Container Size Profile#/Waste Type shipping Document# Treatment F cility <br /> ....................;................................,......._...................................... <br /> 15-gallon open top ':,4 C 2'7 y /a'` tri-�Ci` C <br /> ...................;...._...,....................................................C_............ <br /> 1 . A- T <br /> 10-gallon closed top € 7'Z-741-7 <br /> l...i................._......................._ ./......,..................._......................................... <br /> ........... .................. .............................. <br /> , •i- .... <br /> ­­ <br /> 10-gallon open top ...__. J...y`... <br /> ...............�. <br /> ................... .................._..._.............................. .._..................._............................._........... _ <br /> 5-gallon closed top ; _ .. ............_..._...................................... r................._........................ _ ....... .. .................................._. <br /> ................................._.........._.._ . _.. ...1.........._ ....1� .._._........_`Lg' ._ ....... .../w-`or7........lG'L��fZH//�...................... ........ v <br /> r . ..........._..............._............. <br /> 5-gallon open top ! / 7 t`�VYI ?�c! L/-7 Z � '�` •:�t r� <br /> ........... 1..................................... <br /> ,....................,.................. ...............__..........................,.... <br /> .... <br /> 1-gallon open top J �' /'�s rifl�JS` s�/ '1�� L+( ............................. <br /> ..............;................... ....................................>....................e................... ....... ...... ..................................... ................. <br /> PIH Packaging ................................._........ <br /> ...... <br /> �; € <br /> ............i....................a...._......... ................, ! <br /> :................... <br /> 275-gallon tote .................................. ..........._............ <br /> .. <br /> .........._...........................;.............................................................................. ....................._!......_................................................._:.............,.....................................i......... <br /> CubicYard;Box ! ............ ........................ ............_........................................... <br /> ..................................:....._.rr]]......... _......... <br /> G' L ;� tJ.� <br /> s.. .........................+.... ........ <br /> _.._._........._-........._..._......... <br /> 4ft Light Tube Drum ... ..................... ..._............................_.......... <br /> 8ft Light Tobe Drum <br /> Packing Materials # Transportation Services: <br /> Vermiculite,Bag Number of Containers Facility/Destination <br /> Clay Absorbent,Bag <br /> {....._._........... ................................................................................................................... <br /> ......_.................._........_......................_ <br /> Bubble Wrap,Roll <br /> ..............................._........................, ._............._.......... ......._._....__..................................._...................................._........................_._...........__................................. <br /> Bubble Wrap Bags,Box ;1q c7 <br /> ........................................................ ............................ ......................................... .................................................._.............................._...................................................._......................................................._... <br /> Drum Liners <br /> ....... _..........................................................._...._...... <br /> Pallet , ... .�....._.................... y. <br /> Supersack Notes: <br /> ......................................._...._...... <br /> Radioactive Waste Boxes <br /> Biological Waste Boxes <br /> .......................... <br /> Red Biological Waste Bags Labor: Hours/Regular Hours/Overtime Service Provided <br /> Personal Protective Equipment # Project Manger <br /> Level D Chemist.. .. <br /> f 1. <br /> Level C .............. ... ... ............. .......................... <br /> Technician <br /> ....... ....... . . <br /> Level B ...... Driver <br /> _... ....................................... ............... . . .................................. <br /> Other: <br /> Other Materials # Notes: <br /> ............................... <br /> _....:............................................. Customer Signature Date: <br /> .......... .._..........._............ <br /> PRINT NAME: <br />