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Work Order <br /> 210 Elko Drive 2010 Mission Rood 265 Riggs Avenue 13122 Canaria Road 6137 Edith Blvd. NE Sll Highway 213 work Omer # <br /> ACTL Sunnyvule, CA 94089 Esmndldo, CA 92029 Me«ed, CA 95341 Sunto Fe Springs, CA 90670 Albuquerque, NM 87107 Chaparral, NM 88081 Proposal # <br /> 408 548-5050 P 760 4895600 P 209122-4228 P 714 545-2191 P SDS 349-5250 P 575 824-0164 P Date <br /> o 408 548-5052 f 760 4893625 f 209 722-8228 f 714 545-2287 f SDS 344-7986 F 575 8240208 F Acct. Sales Manager <br /> Customer Information Service Request <br /> Name : <br /> Description : _. .. . . . . <br /> Addre s: ' y�Cjii fll��" .._ .. .__.. . <br /> ..... . .I......... . ............. <br /> EPA ID # CAI 002111 <br /> Main Contact: Jaime Pine" 2094684166 <br /> Phone: - - -" — <br /> ..._ ___. ...._... .. ___. ............. . . _ . . . . . ..... <br /> Secondary Contact: _ <br /> Phone: ,. ... __..._:. _ _ - .........._ _ ................. ... ...._...._...... .............._... <br /> ._.. <br /> PO # <br /> Materials and Equipment <br /> NewReconditioned .. _.... .. .. ... .. __..... ......... . .. . .. .. . .. .. ............................ . .......... ...... . . . . . .._.. <br /> Supplies Metal Poly Fiber Metal Poly Fiber <br /> .......... <br /> 85-gallon overpack <br /> . .............. .......... _...._.. ..... ...... <br /> _ .._.... <br /> 55-gallon closed top <br /> 55-gallon open top ....................... - I d d I I . ... ...... . . . . . .I......-I _ <br /> 30-gallon closed top <br /> 30-gallon open top <br /> 20-gallon closed top _ Services <br /> 20-gallon open top <br /> Disposal Services: <br /> 15-gallon closed top Quantityl Container Size Profile #/Waste Type Shipping Document # Treatment Facility <br /> 15-gallon open top - <br /> _.... ............... ...........III ...:.I I __._ ___ __. _._. _. <br /> 10-gallon closed top <br /> ___.._. ..... ..... ... ............. . . . ........ <br /> 10-gallon open to <br /> ___._. ..._..._. ............ ..... . . ............ . . . I&... I-Idd, I dId Idd, ...- .. .... ...... <br /> 5- gallon closed top <br /> ..........I... ......... . ................ III . . ._........ __......._. <br /> 5- gallon open top <br /> 1 - gallon open top <br /> .......... .. . ......... . . . .... ...... <br /> PIH Packaging <br /> ............ . .. ...... ...:. __.. "I' ......._... <br /> 275-gallon tote <br /> _... ........... . . . ... ...... . .. . .._._._ . <br /> Cubic Yard Box <br /> __ _... . ..... ...... ___. ___. .... ...... .......................................................1:. . <br /> 41t Light Tube Drum <br /> Bit Light Tube Drum <br /> _ __. .._.. ...... . ... . .. ._ <br /> ....... __. ___. . . . I ... . . . .. .. ... . <br /> . . . . . . . . :. . .. .. <br /> I. . . .......... <br /> Packing Materials # Transportation Services : <br /> Vermiculite, Bag Number of Containers Facility/Destination <br /> Clay Absorbent, Bag <br /> ._ . . .. . . . . . .. . . ..... ..... ...... ............ ___ ..._............ . .. . . ........_. . ..................................................I <br /> Bubble Wrap, Roll <br /> . ._.. . . . . .... ... ._ . .. .e. . ... ..................................I..................... ......................._..........................................-..._. <br /> Bubble Wrap Bags, Box <br /> . . ._.._.... . ..._ . _ ..... . - _. . .. . .._.. . <br /> .L....... ..........................................._.................................................I.....-. . <br /> Drum Liners . ....._......... ... <br /> .. ........._........_........... <br /> .............. . .. ......... ... ......_... . ..._.. . .. . . . ........ . . . <br /> . . . .. .. ... . . ............................................................................................... <br /> Pallet <br /> SuperSack Notes: <br /> .................................... .. ... ... ...__. <br /> Radioactive Waste Boxes <br /> ......_..._.-....................................... .... <br /> Biological Waste Boxes <br /> Red Biological Waste Bags Labor: Hours/Regular Hours/Overtime Service Provided <br /> Personal Protective Equipment # Project Manger <br /> .. . <br /> __ . .. .. .. .._... . . . ................. ........... ........... _ ._ <br /> Level D Chemist <br /> .... .................. . . . . ............ ............. ___. ._. .......I......... <br /> Level C Technician <br /> .. . . .._......... .... Driver <br /> Level B <br /> .. ... . .. ...._. .... .... .... <br /> Other: <br /> Other Materials # Notes: <br /> ............................................................... Customer Signature; - -I..,dd,dd-dddI�` Date: <br /> IPRINTNAME : <br />