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Work Order gLP'" <br /> o°I°I°o 12100Io01iN 201011ksiMPad 2658WAvenM 13722(mmmlo Pmd 61371dAM1 Ilk NE 511 HgihwW213 W Chder# <br /> ACei 6uneyrme,fA94089 Esmodido,CA92029 MNud,U9S341 Sema feSplmps,G90670 Mattylue,NM 87107 (hopPlo�NM88a1 Pmppselr 1426x4 <br /> T° 4085405050 P 7604893600 P 109 R1d218 P 7145452191 P 5053475250 P 575824-0164 P Dale 23-OCT47 <br /> ..wro 4085483052 f 7604875625 F 2097228228 F 7145452287 F 5053447986 f S7SB2b0208 F Asst.Salm m,aeger PetFimes <br /> CyiMa Information Service Request t <br /> Name: 'ORgSoc�Wl <br /> Address: 2201 Wadtiypon Ave. Description _.. .._------- <br /> amddmy CA 95201 ACTOduarRetll mustce0 priarto leaving 6w ACTiard to onsurs tlts Port .... <br /> ofBtuekbn rArilbdtTgslane5ra andt"eeayi�rir:-lOAt—ars eatlmamd®artat .. <br /> EPA ID# CAL0060N661 .._tp24#.e6e. _... ........ <br /> Mal.Contact: " waif 186-6613661 <br /> Phone: 4-55-DM-OILY SOLIDS-173634 <br /> oe <br /> Contact: <br /> Phone: -- 176W M OIL RL........ OTG'RUSFE60R OOIILBE PtINCRA2ED <br /> ._..._. <br /> pop n-EA-550NIon Razon MMal Drum U 1 - <br /> Materials and Equipment -'-EA-f%Mb FtbiiiMb Egtdpirien wet <br /> Ni <br /> -MR- <br /> New Recom tlonto . ..... or t3111eP <br /> Supplies .. EA-FwliEnsrgyRecpteryFa•0Y <br /> Mehl Poly Minor Meal Poly Rbar <br /> .................. <br /> 85-gallon overpack I <br /> I <br /> 65-gallon closed lop I - ..............."_""""_—.__..._..."__"_ <br /> 55-gallon open top _--------- <br /> "' " <br /> 30-gallon closed top <br /> 30-gallon open top <br /> 2a-galhm closed top �_- _ _ _ Services <br /> =-gallon open top Disposal Sprweea: <br /> 15-gallondosecitopWagon, Counter SPmaie#AYaete -Shipping D cu <br /> 15-gallon open top 1 <br /> 10-gallon dosed top <br /> 1"Pg.1ellon open top <br /> S gallon closed top <br /> i <br /> 5-gallon opo.top <br /> 1-gallon open tap <br /> PIH Packaging "� - -�— -- ----- <br /> _. _ <br /> 275-gallon tote � -- <br /> .. . <br /> Cubic Yard Boz <br /> 4N Light Tube Drum <br /> Bk Light Tube Drum <br /> Packing Materials # Transportation Services: <br /> Vermiculite,Bag Number of Coned. r HH~1mo. <br /> Clay Absorbent,Bag <br /> Bubble Wrap,Roll -- -- - - - --- -- <br /> nubble Wrap Bags,Box _- -- - <br /> Drum Liners - - <br /> Palle! <br /> SuperSack Nmn: <br /> Radioactive Waste Boxer <br /> Biological Waste Boxes <br /> Red Biological Waste Bags --""---- Labor: Houram ubr Naurbq v m. Service Provided <br /> Personal Protective Equipment Prolan MweM __ <br /> Level D Chemist T ---"— <br /> Level c .._.. . - _ Tech kA n i <br /> Level B ."" pdve, ----- <br /> ___. ..__ <br /> Other Materials # om.. <br /> xa..: <br /> .._..______....................... Customer vgssur6qvr Deb: <br /> PRINT NAME: q-P <br />