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Mei ed,RiggsC Avenue 6511 Colorado Blvd 42 WORK ORDER <br /> HomeOffiee; 6212575th Avenue#4 Mer<ed,CA95341 Commerce(ity,C080011 511 Highway 213 <br /> laveen,AZ 85339 Chaparral,NM 88081 <br /> •i.. 967 Mabury Aoad 600 iosra Street 6137 Edith Blvd NE Work Order# <br /> ro SanJose,(A95133 Redlands,CA 92373 Albuquerque,NM 87107 <br /> ACT 408548-5050P 2010 Mission Road 3b045EAmblerRoad Proposal# <br /> Escondido,CA 92029 Clackamas,0R 9701 S <br /> 408 548-5052 F 13722 Carmenita Road 208 Murrayoad SE Date r>-� L <br /> AC <br /> y JB1-�F � l <br /> Santa Fe Springs,CA 90670 Albuquerque,NM8110S Acct Sales Manager ,� t.„, <br /> 6tl.A49r�Nr :.RkB <br /> Customer Information Service Request pag,.g <br /> Name: Con—.a e Aiff-Avid, k LC <br /> Address: 1413 F. Uaff3mep talo Description:_-.... --_ -,__,_ _______.-.-.-_-.___._-•---.._.---.____. ___.----.-_-.-._._._.... <br /> EPA ID# <br /> Main Contact: ion ���mbi Y1-8� 110 1»gyp«OM-S1041.- 1 7 � <br /> Phone: °150--IND.:?U t'uWc Yatdy C T»Rental <br /> -. .Labor-.ciaa ...............---------------. <br /> Secondary Contact: 4-I-iR-La4a.-C lam A b lver COT <br /> Phone: �1saT.�--._._.___....__._._._._._._._.-._.__.__ <br /> PO# fpm 9 - � t1E��t - <br /> Materials and Equipment <br /> New Reconditioned - __...._._._____._._.__._............_,_,_----_---------------- <br /> Supplies Metal Poly Fiber Metal Poly Fiber <br /> 85-gallon overpack <br /> r <br /> 55-gallon closed top <br /> -------�-._------- <br /> 55-gallon open top i �' r -------___._.__._.._..__.__-___,__.____._........_----------—_.______._.__._.__.__.__. ___.__._..._._._........_._._..._......_.___._.____..... <br /> 30-gallon closed top t_._�_�-•--_— ___.__;,....__._._...__.___._ <br /> _-•-j--__.__._._._._._._._ .............._ --_- <br /> ............._ __.__.__ _._._..._... <br /> —_____._._._._._______ .__--------- _ <br /> .--.----•------._._...___._.,_._._____._._.—._._.__...__..._..... ...._._... <br /> 30-gallon open top <br /> 20-gallon closed top i -^ ; - y Services <br /> ---------------------------..-----.-.-. <br /> --_^^^------- <br /> 20-gallon open top 22 i Disposal Services: <br /> 15-gallon closed top i Quantityl Container Size Profile#/Waste Type Shipping Document# Treatment Facility <br /> 15-gallon open top I NI ll a 1. �l rr; i�� •� S`1 ?U t r�(jJS� « ���N <br /> 10-gallon closed top <br /> 10-gallon open top r <br /> 5-gallon closed top I ! I <br /> 5-gallon open top ' <br /> _ _____ ____._._....._.___._. __ __ ___—._ ..___...__ _— -•---------- ----------- <br /> __. .____ —_____--.--•-•-_-. -------- <br /> 1-gallon open top ' ' <br /> PIH Packaging <br /> 275-gallon tote <br /> Cubic Yard Box I ' <br /> Oft Light Tube Drum ' <br /> _._----- <br /> _--- <br /> .._. <br /> _. <br /> 8ft Light Tube Drum <br /> Packing Materials # Transportation Services: <br /> Vermiculite,Bag -^ - ` Number of Containers Facility/Destination <br /> Clay Absorbent,Bag _ ��LI,_/!�l—_,.,____.,_._..._._.__.__._..._._._.... <br /> _.__._.__.__.__ ...____ __�_..__.__...._..._._ _.___.. <br /> Bubble Wrap,Roll <br /> Bubble Wrap Bags,Box ------_ —__.__.___..l_—_—_._.__________, _ ---_._._...__ <br /> Drum Liners <br /> Pallet <br /> SuperSack -- -------------- Notes: t G ii l <br /> Radioactive Waste Boxes <br /> Biological Waste Boxes <br /> Red Biological Waste Bags Labor: Hours/Regular Hours/Overtime Service Provided <br /> Personal Protective Equipment # Prolect Manger ` <br /> ------------- ____—_._._i......._..-.-._.-_.____._.-_.__.___.____._._._.___._.__.____...._.___. <br /> Level D Chemist r <br /> Technician <br /> LevelC -.-.-__-•`-•--•----- -.___._.___-_.__..._..... _._ .-•-----.____.___ .-___ __._ ._..._____ ___._-.-- <br /> .. .............__...__.._.._....' Driver ' <br /> Level B I............ <br /> ._,,�l��._te_.�__,_ __._.__._.__,_______.-•---•-•-- -._._-_._,. .,___,,._.--•---._._. _...._._.__,__._.__._._._._._.__._. <br /> Other: 3 <br /> Other Materials # Notes: J <br /> Customer Signature: { RT � _.,. Dale: ) r l <br /> PRINT NA / <br />