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Work Order <br /> =� �� 210 Elko Drive 2010 Mission Road 261 Riggs Avenue 13722 Corrnenita Road 6137 Edith Blvd. NE 511 1 hlvoy 213 work Order # <br /> /�. Sunnyvale, CA 94089 Escondido, CA 92029 Me«ed, (A 95341 Santo Fe Springs, (A 90670 Albuquerque, NM 87107 Chaparral, NM 88081 Proposal # <br /> ACT 408 548-5050 P 760 489-5600 P 209 7224228 P 714 545-2191 P 505 349-5250 P 575 8 24-016 4 P Date tiJL-18 <br /> 408 548-5052 F 60 489-5625 F 209 722-8228 F 714 545 2287 F 505 3447986 F S1S 824-0208 F Acct. sales Manage Bmace WtsEcuti <br /> Page P <br /> Customer Information Service Request <br /> Name: <br /> Address: Description .. ... . . .. .......... ..... . . . .................................._...a........ <br /> . . <br /> EPA ID # . .......... .. ............. ............. . . <br /> @ - <br /> Main Contact: - <br /> t . <br /> Phone: � _..... ............... <br /> t - 8 . <br /> Secondary Contact: _ .__ ..... . ......... _. . ...... . . ......... <br /> Phone: _ d.1 ,. .ai. .... ._...: _.._.._trveey r<frf- - .......... . . . . . . ......_ .. _ ....... . ... I.............. <br /> PO # <br /> Materials and Equipment <br /> New Reconditioned . ..._. ............... . . _ - . _. . .._ . ......... ............... ._. <br /> Supplies Metal Poly Fiber Melal Poly Fiber <br /> 85-gallon overpack . . . ............ .............. <br /> 55-gallon closed top - - ._ ................ ....._.. . .... .. ........... . . . <br /> 55-gallon open top ... .. ... . ........... __.. .. . . <br /> 30-gallon closed top <br /> 30-gallon open top <br /> 20-gallon closed top Services <br /> .....� ...... ....... <br /> 20-gallon open top <br /> . ......... .......... ........ ....... Disposal Services: <br /> 15-gallon closed top _ Quantity Container Size Profile #/Waste Type Shipping Document # Treatment Facility <br /> .........._.._.. L._........ ..........-._. <br /> 15-gallon open top - <br /> . .. .........._. _...... -.._..- . . ......._ ... <br /> 10-gallon closed top - - "- <br /> . . . . _..._ . . - ......10-gallon open top " " <br /> 5- gallon closed top ""- <br /> ._._.._.._.. . ......._.. I. ...... ._....... ... _ ......... .. . '.... ......... ............... _. . . ... .. ._ ._ ... . . . ...._._..... <br /> 5- gallon open top - <br /> 7 - gallon open top <br /> t . ......._.. .............. <br /> ................. ............ ........_.. <br /> PIHPackaging __.._. . .. . . ...._...._.._ . . . _ . .... . . . . ............ <br /> __. . . .._ .. . . ....._.. .. . . -..... . ..... _......... . . . . . . . . . ......... .... ... ...... . . . .. ...... ........ <br /> 275-gallon tote <br /> Cubic Yard Box - 7 t -. ............... ,y .. . <br /> . .. <br /> ........._ . d......... __. .. ............. _..... . . ._ ....... . ...- ................ <br /> Oft Light Tube Drum <br /> Sit Light Tube Drum " - __-- - <br /> Packing Materials # Transportation Services : <br /> Vermiculite, Bag + IdNumber of Containers Facility/Destination <br /> Clay Absorbent, Bag i - <br /> Bubble Wrap, Roll -" <br /> Bubble Wrap Bags, Boz <br /> Drum Liners <br /> Pallet . . ......... -..._... ... <br /> SuperSack Notes: <br /> Radioactive Waste Boxes <br /> Biological Waste Boxes <br /> Red Biological Waste Bags Labor: Hours/Regular Hours/Overtime Service Provided <br /> ddIdd <br /> Personal Protective Equipment # , Project Manger <br /> .. .... ....... <br /> Level D Chemist ... .............. .......... <br /> Level C ........... . . ........... Technician <br /> ................. ... ._. <br /> Level B .._... ._..._.... "Driver __.... _........ __ <br /> .......... _...... I I ......... .._.... .............. .............. <br /> Other: <br /> Other Materials # Notes: <br /> ............................................................I <br /> ....___.................III. ._......_............_.. Customer Signature: Date: �, c <br /> .._.................._..............dd- <br /> ..............._....- l/ <br /> PRINT NAME : <br />