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Work Order <br />Marrad, (A 95341 Sulayella, (A 94089 fxandido, CA 92029 Santo Ane, to 9$707 <br />ACT265 RIM A"AR 1210 8ko Drive 2213 Meyers Aydnue 75015, 51, Saila 8 <br />409722-4228 r 408548-5050 a 7604895600 P 71454}gi91 P <br />209722-8228 i 4085485052 r 760489-5625 r 714545-3287 6 <br />work order A ! 1 <br />Prapaaal a <br />DNa <br />pccaun silpat�na0er yy� - <br />Cust4snw tnfomtation <br />Service Request <br />Barre: GRWLLCdbaV*RWTovftprroduCU <br />Address: 1313 3alAh M,odtton Strut <br />Lodi, G 95240 <br />EPA IDN CAL ODD 30278Xw=TtxkbCdM <br />Main Contact coo ma rw <br />Phone: W_90DIM <br />SecPhone: Contact <br />Phrase: . <br />PO z <br />Description: <br />wank otdar# 11884... <br />D*-- 194=41 <br />CHECKEDJUN2--02012 <br />-- <br />I —TT —Vacuum Truck wate—109670CA - -1,1 <br />I-LaborTwksr2kiver <br />-L_. _... .. <br />I—Pawonal PCOtIXLivc E.4ra1Ti <br />1—Fuel A&iefrRecovery Fee -3.9% <br />I — waAklout Fee <br />Manifest and Generator Information <br />pa Fall Pas Fall Reaainl) <br />C for CA pH-Cantniners <br />US DOT Description (irteiuds proper shipping rtarrea, Hex class an ID) an <br />Mon xarao4u4Waft Liglud l i <br />Confainarinrormation <br />` Ty" <br />TT <br />To[al <br />o„emhy <br />,Im <br />W R0ftyalame <br />a <br />Gong ratur EYA ID NO <br />_ } <br />---- <br />Mantfes( Nu; b�BA}tHIflOflY PaY�]?618d Transporter 10 No <br />Designated FaciNY and address � Is&1dilll $_ _ <br />_— aro4rsx <br />Livcrtroae, 4'MA 9455] <br />Phones �� dSi?ZAr _ <br />use eve rDa ....CAD 941 �� <br />swa ap a __ <br />OtsposalServices..r <br />Trans on Services: <br />Manifest Hamper Slxo P�orite# tTfv Type <br />Number of Canhatrx,rs. FacitayWastination <br />New Reeondit1onW <br />duanlN Nies, Supply Dencnpnon <br />.Sutivilea <br />Metal Poly Filrm plater Paly Fiber <br />�. ra SS vrc "';Vkr v .'V <br />t/`r <br />55-ga0on closed top <br />_. <br />.... ... <br />55-gation open top <br />30 -gallon closed top <br />30 -gallon open to <br />15 -gallon closed top <br />1"allon open top <br />Lnbor: NaurslyEa alar HourslOvortimc Service Provlt}ed <br />5• gallon closed top <br />Project Manger <br />Technician _$ s gi., .Kai. � ... _... <br />Driver <br />CNher <br />5 -gallon open top <br />275 -gallon tote <br />Cubic Yard Box <br />_.... -. <br />ftLighf Tuhe Drum <br />Customer Signature: <br />Date: <br />8ft Li ht Tube Drum <br />vermiculite, Bay <br />Clay Absorbent, Be <br />PPE <br />