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Work Order <br /> 1210 Elko Drive 2213 Meyers Avenue 265 Riggs Avenue 13722 Cormenita Rood 6137 Edith Blvd.NE 511 Highway 213 Work Order# <br /> CT Sunnyvale,CA 94089 Escondido,CA 92029 Merced,CA 95341 Santa Fe Springs,CA 90670 Albuquerque,NM 87107 Chaparral,NM 88081 Proposal# <br /> A408 548-5050 P 760 489-5600 P 209 722-4228 P 714 545.2191 P 505 349-5250 P 575 824-0164 P Date <br /> 408 548-5052 F 760 489-5625 F 209 722-8228 F 714 545-2287 F 505 344.7986 F 575 824-0208 F Acct.sales Manager <br /> Customer Information Service Request <br /> Name: CallOt.rt z" 4 iA,ii' "ri 3,v <br /> tllov Of" Description: _._............................................_........_....._....._....._...........................__......._...._....... ..._._... <br /> Address 1105 +. F3 tkirado 'll <br /> .. <br /> EPA ID# .. _...._ ........._..._ <br /> MainContact: :i 4k PJ14- 7 .............. ...._ . ..... ._.... __. _.............. _. . .........._.......... <br /> Phone: <br /> Secondary Contact: ;t <br /> Phone: .,,...y_...:a... ..-. ...... ..... _. ......_.......... <br /> Materials and Equipment <br /> New Reconditioned ........................_. .. ....»............._..._..__................................._.»__.............»......................._...................... <br /> _...__... ,....».......__......._»._._.._.......... <br /> Supplies Metal Poly Fiber Metal Poly-1 Fifer <br /> 85-gallon overpack <br /> ............... ............ <br /> _.__.._ _.......---------- <br /> ._»........... <br /> ..... <br /> _...... <br /> _................ <br /> _................... <br /> 55-gallon closed top <br /> ................_.,_..._............ ..._._._ <br /> 55-gallon open top i _..—__.___.__._..____..............._....._.............._............._......_....................__._..._..._...._........_......................... <br /> _._....._.... <br /> ..........._..................................................................... <br /> .......__._ <br /> 30 gallon closed top .................... ....._.....................»..................................._.................................»._................................................ <br /> ....................�.................. ..............». E ..................... .... <br /> 30-gallon open top ! i <br /> ......._._........r.................._i-........._..."_ '__.._._.._i.._......................_........... <br /> 20-gallon closed top I 1Services <br /> ..........i......»............ _............._..{................._...................... <br /> 20-gallon open top Disposal Services: <br /> .»..................._.._:_........._....... ......................... _._r........__. <br /> 15-gallon closed top 1 ....... <br /> Quantity container size Profile#/Waste Type Shipping Document# Treatment Facility <br /> i...___._..._.. ................»;»................... <br /> ...._......»...... <br /> 15-gallon open top 1 . ....................... <br /> _.........._i».._.............._......_....._ ..........._._.i.....................:...._...._.... <br /> 10-gallon closed top i - .... ........ <br /> _...«_._._......_.:_.__...._. _._. ._._._........._............... ........__._...-................_............................_ ................. <br /> 10 gallon open top I t ........_........................... ......... <br /> ...................................;.................... ....,..................................................._..._ <br /> .............._.._1»........__..... ... ...». ... ,.r.......... <br /> L- .-;;r, <br /> 5 gallon closed top _.......................... <br /> 5-gallon open top { _........ ..._.......__......._..........._.................. ....._................................_................. <br /> ....._........_;...._. ....i......-_».»... _............._;_..__...._..._.j.._............... ................. _..._........_... <br /> 1-gallon open top i <br /> _........................._._...... _...................................«................ <br /> PIH Packaging ? € ? _.............. _......_..._...................._ _.......................... <br /> .......___._.._.......__._.....�...._...... . <br /> _.._............€..__.............»3......_........... ............. ............._._................... <br /> _.._i................_..__.._..... <br /> 275 gallon tote ..........._........................_....... ....._....................................................._ .......................................................... <br /> .............._......................:_.._..._........ ._............_...;...,.................j................... ....._..........;............_._._....._....._._......!..... <br /> Cubic Yard Box <br /> ...................1................._ ..._......._..._:..._...............,..........._....... ..........._....r..........._.....................__........:......................................................................................... _ <br /> 4ft Light Tube Drum i <br /> .....__._.. <br /> ......... .. ................ .... .... _ ,. ... _. _ _. ._.._. ............... ...... _._ .......... <br /> 8ft Light Tube Drum <br /> Packing Materials # Transportation Services: <br /> Vermiculite,Bag Number of Containers Facl I ity/Desti nation <br /> Clay Absorbent,Bag <br /> Bubble Wrap,Rolf <br /> Bubble Wrap Bags,Box <br /> Drum Liners <br /> ..................._......_........ <br /> Pallet <br /> .......................... <br /> SuperSack Notes: <br /> Radioactive Waste Boxes <br /> Biological Waste Boxes <br /> Red Biological Waste Bags Labor: Hours/Regular Hours/Overtime Service Provided <br /> Personal Protective Equipment # Project Manger <br /> Level D Chemist <br /> Technician <br /> Level C <br /> Driver <br /> Level B <br /> Other: <br /> Other Materials # Notes: <br /> Customer Signature: Date: <br /> PRINT NAME: <br />