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Work Order <br />Mated, U 9534t Sunnyvale, G 94989 &taadrda, @ 92924 Smto An to 92707 <br />� � 263 Riggs A95341 12n0 ult OA 7 2213 Mayen 97029 Stat Sn (A 9 St, Stull 8 <br />2091221228 P 498 540.5950 r 769 489-5600 e 714 5452191 r <br />- - . .. .. 209 727-0770 I 498 5495952 r 160 4893625 I 114 545.2287 t <br />v/� Drdor R <br />Proposal M <br />Dam <br />Account salsa Mana ar: E.c-iatt T <br />Customer tnietMation <br />Service Request <br />Name: 4 RLCLZ.CdbaValfl1e♦y�TJtnringProductsDesc:ription: <br />Addlesv I Li SLN0 l st{N_ktoll Vtl '_1 <br />11,1-A Q5240 <br />EPA ID If CAI OW 348 279 <br />Main Contact. Cody Mayor <br />Phona 309-200-2884 <br />Secondary Contact: <br />phone" <br />Po r <br />work ordrr#:31.5'4... <br />ZetC_1.St_DE�.AI <br />Y12MTrssc1 Sarvf aa_ <br />5 Ti - Vuoxjm. Trutt WaAe - 169670CA <br />I - Labcr Tanker Driver <br />i Frt-ttuve Egdipriltri—levt,L <br />_... <br />I - F' ucl & EnCrW R ec"v=7 Fc,e -15011 <br />Manifest and Generator tnformiation <br />. real, Feil <br />pass Fail Ruuin ID <br />Container information <br />Containers Total <br />No. ryea Quantity wai&Womme <br />Chlor D -tett all <br />US DOT Description (include proper shipping name, Hu class and ID) <br />lim HaLwdov,,; Warte, Liquid <br />i <br />TT I :Vw <br />1 <br />G <br />3 <br />I <br />CSI 00 5+40 <br />Manifest Number ?1_ 1-2 Transporter ID No i"AR <br />Generator EPA ID NO. CAL OW 349 <br />279 <br />Designated Facilty and address Altatnc at Landfill & Risourcc Recovey Facility <br />Fa Aity Mone # (P25) 455-7301 <br />10&1 O s kL rriu tL Pass Road <br />AV'ITP!'x-e,t n.'!d5;1 <br />MA EPA W S CAD 981 38Z 732 <br />sumwa <br />Olvaf Services: <br />Transportation Services: <br />Maneeatkurnber va Proflle9 QTY Tam <br />Fkimberof Dontalrrara PaceayfDastaatiwr <br />kew <br />Aaconditierred <br />Oumitq MM[. 6aPMybastnDaon <br />Supplies <br />Maul Poly Fiber <br />Metal I PO4Y I Fiber <br />. _.... <br />55-galbn dosed top <br />.. <br />_ <br />55 -gallon open top <br />30 -gallon closed top <br />30-gation open top <br />15gallon closed top <br />1"011011 open top <br />Labor; NoursiRe filar NoulsfOvertime Service Provided <br />5• gallon closed top <br />pmivut Manacr, <br />Clmmist <br />Technirtan, __ qq�_�� -ry <br />5- gallon opon top <br />275 -gallon tots <br />Cubic Yard Box <br />:......... <br />aft light Tuba Drum <br />Customer Signature; <br />Date: <br />Oft U ht Tube Drum <br />Vermiculite, Bag <br />Clay Absorbent, Bag <br />PPE <br />