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Other Materials <br />Driver <br />Other: <br />Notes: <br />Customer Signature: Date: <br />PRINT NAME: <br />Work Order <br />04110 1210 Elko Drive <br />2010 Mission Road <br />265 Riggs Avenue <br />13122 (annenita Road <br />6131 Edith Blvd. NE <br />511 Highway 213 <br />#A�5unnyvnle, <br />fA 94089 <br />Escondido, fA 92029 <br />Merced, [A 95341 <br />Sonta Ee Springs, fA 90610 <br />Albuquerque,NM BI101 <br />[haparrol, NM 8808177104 <br />�' 408 548.5050 P <br />160 489.5600 P <br />209122.4228 P <br />114 545.2191 <br />P <br />SOS349.5250 P <br />515 824.0164 P <br />FWorkO,,d:er <br />408 5485052E <br />160489 S62S f <br />209122 8228 f <br />114 545 <br />2281E <br />SOS 3441986 f <br />S75 8240208E <br />24-JUL•15 <br />Manager 8auca Welt Gott <br />Customer Information <br />Service Request & <br />Name: Bwvtech Remurvo Parovery <br />Engimeting I <br />Address: 1820 Inds, Mal Dr, <br />Description:...................................................... <br />SttackWn, 4A 9UW <br />............. .. .... . <br />A ID # NON liriZ <br />_ ._ .............. .. ................ .... <br />Main Contact: Paul t Ip :t7 -. a68t <br />...................... _........ _ . <br />- SORETECH - RINSE W ER - ACT28963___._ _.:...... <br />..............................._........ ....._. <br />Phone: <br />EA- Pamongl Prollec e..Equ' <br />t, pmartt-levet D <br />—E.A_+eel•$t Ens+fp�CRaFto�re� f+*3e _ ga6 ._....................__............................... _. <br />Secondary Contact: <br />Phone: <br />PO # <br />Materials and Equipment <br />SuppliesNew <br />k--t-7lPoly <br />Reconditioned <br />Fiber <br />Metal Poly Fiber <br />85-gallon overpack <br />55-gallon closed top <br />55-gallon open top <br />30-gallon closed top <br />30-gallon open top <br />20-gallon closed top <br />Services <br />20-gallon open top <br />Disposal Services: <br />15-gallon closed top <br />Quantityl container Size Profile #/Waste Type Shipping Document # Treatment Facility <br />15-gallon open top <br />allon closed top <br />10-gallon open top <br />5- gallon closed top <br />......... ......._.,..._.... _ <br />..... <br />5- gallon open top <br />...........-_................................................._ ............... <br />1- gallon open top <br />............... .... .........................._......................_..................__.........................................._......._...... _... <br />PIH Packaging <br />................. _....................._.................................. .............. ....................... -............................... ........ .......... .t......... ......... .... ....... <br />:..... <br />275-gallon tote <br />_. .. ........................ ..... ................ .. . . <br />Cubic Yard Boz <br />.......................................... . ._ <br />4ft Light Tube Drum <br />__.....................:........................_.................................;........... ........................................................... ............ . _ . <br />a............. <br />811 Light Tube Drum <br />..................'s...............................................................;........................,........................................... <br />Packing Materials <br /># <br />Transportation Services: <br />Vermiculite, Bag <br />Number of Containers Facility/Destination <br />Clay Absorbent, Bag <br />Bubble Wrap, Roll <br />Bubble Wrap Bags, Box <br />Drum Liners <br />Pallet <br />SuperSack <br />Notes: <br />Radioactive Waste Boxes <br />Biological Waste Boxes <br />ned oiuioyicai vVaste 3ag5 <br />Labor: Hours/Regular Hours/overtime Service Provided <br />Personal Protective Equipment <br /># <br />Project Manger <br />Level D <br />/ <br />Chemist <br />Level C <br />Technician <br />Other Materials <br />Driver <br />Other: <br />Notes: <br />Customer Signature: Date: <br />PRINT NAME: <br />