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ggs Blvd Avenue 65 1 HomeOtfiCe: 6212S75ihAvenueY4 Merc265 ed.(A 95341 Commerce City,(0 8002 2 S11Highway 213WORK ORDER laveen,AZ85339 Chaparral,NM88M1 � • � 967 Mabury Road 600 Iowa Street 6137 Edith Blvd NE Work Order# San Jose,CA 95133 Redlands,CA 92373 Albuquerque,NM 87107 A�� 408548-5050P 2010MissionRoad 13600SEAmblerRoad Proposal# 408548-5052F Escondido,CA92029 ell V1110 13122(armenilaRoad 208 Murray Road SE Clackamas,OR 97015 Date Santa Fe Springs,CA 90670 Albuquerque,NM 87105 Acct Sales Manager Customer Information Service Request pac.'i o' Name: .. Address: �"1414ah C-4fi'winda, Lg"M,' Description: 4919 E L-at$rf44 Road __....._..._..___._._..__.____._..._........__..__.___..._.__.___._.__ _----_-_--------------.---------------_----_...__._._._._._. L-Mil1 ap, C-A�"�1530 EPA1D# _._._._.__._._._.____._____._____ MainContact: Ta .g , _.......... -_.-.-------------.__---------------_--__.__—..__._.-__._.__.. Phone: t -EA-Anal ?ah; Secondary Contact: -.__.�._��FA.� .��tti��'�.��----•-•---•--•--_«._._____._.__.__.._..____..._._.-.._______.__..._._..__._._. Phone: _._ DiVi-811 ,20 Cubir,VaNCT-.Rental.__._._.____.____._.__.__.___.___..__.____.__ ._.__._... PO# _ ._ � _.........4..40- Materials and Equipment 1 a FP.-Fly;>,wival Prokirdl'i a EgUipment-.lmrak��1 C. NewReconditioned64......___._..._...._.--•--.._...._._,.......,_.........._..._.......___«__,_ Supplies Metal Poly Fiber Metal Poly Fiber 85-gallon overpack I......_._._....c_._.__...__...____..__.._....._,_..._..j.__.__._..... _.____ -__._._. _._ ._..._.___-._.._._.__........-._._--------,------._._.__._.._..._...._..___..._..........._......... ._._...._.-- 55-gallon closed top i 55-gallon open top �-•----•----'_._.._.__.___.....__._._. ._.___.... ..... 30-gallon closed top r 1 , -r........................ ...........___.._.__._._._______----.---_______._._..._._.._..._....;._._._._ __._.__. _-__-____ 30-gallon open top ............F..._._._._..__.__._._._.._.__._.__ 20-gallon closed top Services 20-gallon open top Disposal Services: 15-gallon closed top Quantityl Container Size Profile#/Waste Type Fqhlppi.g Document# Treatment Facility 15-gallon open top ._�z ._._._....._...... 10-gallon closed top , _ r 10-gallon open top - 5-gallon closed top I 5-gallon open top 1-gallon open top r PIH Packaging r 275-gallon tote Cubic Yard Box 4ft Light Tube Drum 8ft Light Tube Drum Packing Materials # Transportation Services: Vermiculite,Bag Number of Containers Facility/Destination .—.--_.__.. Clay Absorbent,Bag Bubble Wrap,Roll _._____._._____ __._- ._. ___ _----.-.-•-._-�._.-.------------------_ Bubble Wrap Bags,Box Drum Liners Pallet SuperSack --_—_`- -_ Notes: Radioactive Waste Boxes Biological Waste Boxes Red Biological Waste Bags Labor: Hours/Regular Hours/Overtime Service Provided Personal Protective Equipment # Project Manger ......._.__.--.._-__-•---.._._. Level DChemist I Technician Level C __...... .__..__.___ ._._.._....-..._._...._._._..__._.. Driver LevelB . I _____•_.__-.__._._. ...._.__.__..._......................_____._._ ._. _.__.__._.___. Other Materials # Notes: ------ _ __. Customer Signature:_` Date: %` Gq PRINT NAME:S. r�;