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Work Order <br /> %600 1210 Elko Drive 2010 Mission Rood 265 Riggs Avenue 13122 Cormenim Rood 6131 Edith 81vd. NE 511 Highway 213 work order <br /> ACTSunnyvale, CA 94089 Esrondido, CA 92029 Merced, CA 95341 Santo fe Springs, CA 90670 Albuquerque, NM 87107 Chopo«ol, NM 88081 Proposal # <br /> 408 548.5050 P 760 4895600 P 209 7224228 P 714 S4Sd191 P SDS 349.5250 P S75 8240164 P Date - -. <br /> em iro 408 548-5052 F 760 489-5625 f 209 722-8228 F 714 54522 F 505 344-7986 F 575 8240208 F Acct. sales ManagerFF <br /> - <br /> . Cu Formation Service Request <br /> Name: ,,5� 1d41re Avr: - <br /> Address: Y Description . . .. . .. ........... ............... ......_,......... . ..... ... .. .... ...III....._.... _............................ <br /> ... <br /> Ullfropt CA 95330 <br /> .... . .. .. I ....... ........ ........,-- <br /> EPA ID # Ci all Pi6eeda 20045&8156 ... .. . Y6 m'E;fr 4 tg: ir°t,L'r'i55P:. iSdP-L?dt.-. . <br /> Main Contact: 5 ° _.rap <br /> Phone: <br /> ..3.._.MR ... . . . . . ..._.... .........Secondary Contact: 11 .11 <br /> Phone: RICK MTCF�. t � � <br /> - . . <br /> PO # <br /> Materials and Equipment <br /> NewReconditioned .................._..._.._........_.............................-.........__._................._.............__........................................._...._...................._...................._..........................................._... <br /> Supplies Metal Poly Fiber Metal Poly Fiber <br /> 85-gallon overpack <br /> 55-gallon closed top <br /> 55-gallon open top IF I <br /> I .. . . .. .. <br /> 30-gallon closed top <br /> 30-gallon open top . ......... . .. .. ............. <br /> . . . .... ......... ...... ....I <br /> 20-gallon closed top <br /> .._ .. . ._._ ... ........ Services <br /> 20-gallon open top <br /> ......_ ...... ... ....... ...... Disposal Services: <br /> 15-gallon closed top quantiTy Container Size Profile #/Waste Type Shipping Document # Treatment Facility <br /> 15-gallon open top <br /> 10-gallon closed top <br /> 10-gallon open top <br /> IF <br /> 5- gallon closed top - ........ ................ . . _. ... .......... .... . <br /> ...__...... .............. .. _......... _. ......._ ... .. ............ . . . ..... . . . . . <br /> - ....___ . ... . ._...... . , . ...... . . . .......... <br /> 5- gallon open top <br /> .._........... :. .. ...... .... .. . . . ..... ......... ! .......... . .. .. . . . .......... IF_ .... .. . .......... <br /> 1 - gallon open top <br /> . . ........_d ............_ . ..._.... .... __ ..i..... . . ............... .............. . ......... . ..._....... <br /> PIH Packaging -- <br /> ... . ........... .........__ .. ...... .... __ ......... .... __....., . . ...... F-...... <br /> 275-gallon tote <br /> .. ........._. -..._.... . . ...... .` ____. ._. ... . ....._.... ............................... ...... .......... . _. . . . .... <br /> Cubic Yard Box <br /> ___.........- . ..... _ ........... ....._... .._ .__.... ...... . ..... .... .... . . ............ <br /> 4ft Light Tube Drum i <br /> ....... ._. ......._� FFFFF . ........ . . . ...... ... <br /> 8ft Light Tube Drum ' ' ' <br /> Packing Materials # Transportation Services: <br /> Vermiculite, Bag Number of Containers Facility/Destination <br /> Clay Absorbent, Bag <br /> . . . ........... . . -+.F. I- ................. .. . ........... . . ................. . . .......-. . . ............. <br /> Bubble Wrap, Roll <br /> . . . ...... . .... .. .._.. ... . ...... ........ .. . . . ...._ . . ......... . . ....... . . ..... .............. . . . ._....- <br /> Bubble Wrap Bags, Box <br /> . ................. . . . „ . ....... ... .. . .........__ . . . . . . . _......... ..:..__. . .._..... . .. ............ . _ . . . .IF . . ..... <br /> Drum Liners <br /> Pallet . . . -...qv....... . . ......... ........ .... . . .. . . . . . <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 /> ... I ....Level D Chemist <br /> Level C � � Tech I't c a . 1/f <br /> Level B Ct Y ._.. <br /> ... .. . .... D 'ver ...... -_ <br /> Other ' - <br /> her Materials # Notes: <br /> 11 6.611, IF IF <br /> .__ . Customer Signature: e; <br /> PRINT NAME : <br />