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Work Order <br /> Work order <br /> I 1210 Elko Drive 2213 Meyers Avenue 265 Riggs avenue 13122(ormenita Road 6131 Edith Blvd.NE Cha NrralCT ,N 88 60 t:� <br /> Sunomle.(A 94089 Escondido,(A 92029 Merced,D 95341 Sooto fe 5priop,D 90610 Albuquerque NM 81101 (hapomal NM 88081 P�sal# i't y,t A <br /> 408 548.5050 P 760 489-5600 P 209 722.4226 P 714 545.2191 P 505 349-5250 P S75 824.0164 P Date � <br /> 408 548-5052 F 160 4891-5625 F 209 722$228 F 714 545-2287 F 505 344-7986 F 575 824-0208 F Acct.sales Manager <br /> Customer Information Service Request <br /> I Name: k�lz� i nev Description: �... -....._.. ......... --._._._.._..._............_.._.._............... <br /> .. <br /> Address: ,, AtaP#iri a 00 <br /> ............ __._. __._..... <br /> 4*rram CA Mils <br /> _..__.........._.__............................_.____..._._ __..__._..---.._._._. <br /> EPA ID# CADOW f GAN= j -6M-TC-At UEMS PAR'T'S WASKR WAM-IMMA IE+ <br /> Main Contact:Jack _.......___._...____..._.__.__.._. __._.......___. <br /> Phone: 8n�c.iA rye.........._.._....._.._._.__. .—....__._.._..........._...._......................._...._..__._._.._............... <br /> Secondary Contact: 1 -EA-Wmh Old Fe _ _....._._ .__.............. <br /> Phone: _ - _ <br /> PO# `'� f JC1 � ^ i -El►��t�t ��Y�+�tcx�'��c're:-_8°:6......__._..._.___.._.._..................................__...._......_._._...._...__.._..... <br /> Materials and Equipment . ...... <br /> _.......... <br /> ...... <br /> ........ <br /> ....... <br /> _... <br /> New Reconditioned <br /> .......................................... <br /> Supplies Metal ! °oly Fiber Metal Poly Fiber ..... _ . <br /> ..............._....._._..._........ ._.__.._....... - <br /> 85-gallon overpack _.».___...._.._._... .._.. <br /> _......4--._----------.- ..... _. ........_;..._........_................_....... __._.. <br /> .JUN..�..�.��t ..... <br /> 55 gallon closed top .........._..........._......_......1._.__..._. ! ! . ... . ..� _.__...._....._..-_.-_.._..........__...._.._........._._».........__....._......._....._..................._.. <br /> ;- <br /> 55-gallon open top <br /> __........__ _._..—.___.....__.._......_...................._...__ <br /> 30-gallon closed top .................._........ ....... ...__......... _..........._............._...... ............... ......................._..._ __.._».. _ ._....»...._.._............ENVIRONMENTAL <br /> ... _.._...._..__.. _._....__..._... <br /> HEA <br /> ARTMENT <br /> 30-gallon open top € __,.--___._..__.._»_........•----- <br /> 20-gallon closed top i ! Services ----' <br /> h es i <br /> 20-gallon open top ! -__-_--.---.- __. _...___.. � P g Facility <br /> Disposal <br /> 15-gallon Closed top Duantity Container Size Profile# aste Type Sip in Document# I Treatment <br /> _................_;..._..._. _......_._. ...... <br /> 15-gallon open top s ! ..... �._ ..._....._.._.._.4. .. ...... _... .... .tir _._. �.. ___......... <br /> _...... <br /> .. _ »._..__..,__._......_.___...... <br /> 10-gallon closed top € i _...._._.._....._._........_........ _....._..... <br /> -----_.............._._..... __..._.......................». _....__._.._.»...._......... <br /> 10-gallon open top i __ ....__._____...__._ ___.._._..._..____ ...._..__ ...-..»_..—._.__ ______.____._._ ...._ _ ......_..........._.._.._.._._.__._.._._ <br /> 5-gallon closed top ' ; ' _._.__._........._ _......._..._......._.._..._._...._.__... __......_..__..............._......._............ _..... <br /> ...._ ....L_. <br /> T.. <br /> __;..._ <br /> _......_...._ __............._!.............._.. ..._. <br /> 5 gallon open top € ! _.�....__...__....._..._....__ _........._ _»...._..._...._._ .......___------- <br /> _._..____ _»___......__....__...__.._ ___..._....»....__......_.._ <br /> ......................._..................._............ - <br /> _ ._......._...... ...._......................_.._. <br /> __.... <br /> 1-gallon open to ,» <br /> PIHPackaging _...1...._.__._.__i_...._...._ __......... _....._».._......_.___ ___._.._..__.._.___. �...__ _._..___..........._....__.. _.......____._..._........_..... <br /> .....».............i................»..�_........_.... i I <br /> 275-gallon tote i _.........................._._. _ — .._.._._.._ _ _....... ___._........__..............._._.._... _...._................_.........._............. <br /> �:_ h <br /> .................... <br /> Yard Box ....... . <br /> ii ____._................................. ...._...._.............._......._....._.... <br /> Oft Light Tube Drum 1 _....._.. !._....._.._.!_........_.._ -_.__ <br /> ;.....__ __.._...._.. <br /> 8ft Light Tube Drum <br /> Transportation Services: <br /> Packing Materials # <br /> Number of Containers Facility/Destlnation <br /> Vermiculite,Bag ......................................................... .. <br /> Clay Absorbent,Bag <br /> Bubble Wrap,Roll ..........._...._................._...._.»........ <br /> Bubble Wrap Bags,Box _...................... <br /> Drum Liners <br /> Pallet ............_................_............. <br /> Notes: <br /> SuperSack , <br /> Radioactive Waste Boxes - <br /> Biological Waste Boxes ular Hours/overtime �e vice Provided <br /> Red Biological Waste Bags Labor: Hours/Reg s__-_.r—•- <br /> # Project Manger <br /> Personal Protective Equipment Chemist <br /> Level D _.. _..._............._.................. <br /> Technician <br /> Level C .................._.................. Driver ! <br /> Level B ether: — <br /> Other Materials # Notes: <br /> .......... -_......_....._. <br /> Date: �, ;• I <br /> ...........--._.................._..........._...... Customer Signature: ; , :' .•� <br /> ...........__...._................ <br /> _. - <br /> ,. ,. ;•,. <br /> PRINT NAME <br />