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- - - - - - <br /> - <br /> SERVICE AGREEMENT <br /> " IF IF ar _ • amm " Ma • 21 Great Oaks Boulevard <br /> .. w • . ■ ■ f <br /> . . r. w Al SE <br /> � ir �■.� r � '�'�'� � � � San Jose , CA 95119 <br /> poll Hazardous Waste Removal , Inc . Phone : (408) A 95178 <br /> Fax : (408) 624 -9335 <br /> Contractor's License No . 992495 <br /> Site Information <br /> Customer. Service Date: <br /> i <br /> Site Address : % ? % Fop <br /> City, State, and Zip ` � ¢j� t' � J �� J,��� _3 Project Number: <br /> Contact : (� %) d' IF (.. i f <br /> Phone Number. <br /> Scope of Work <br /> f " � @o/ <br /> Labor Project Notes <br /> Name Start Arrive Depart End <br /> IF ) IlIz IF pop,. IF I f lop? lop ,IFF " <br /> I <br /> ❑ Customer requests All Clean to submit <br /> copy of manifest(s) to DTSC. <br /> Supplies/Equipment <br /> Qty supplies Qty Poly OT Drums Qty Metal OT Drums Qty Fiber Drum/Boxes Qty Equipment <br /> ❑ PPE - Level D ❑ UN1 H2 . 55 Gal ❑ UNI - 55 Gal ❑ UN1 G . 55 Gal ❑ HEPA Vacuum <br /> ❑ PPE - Level C ❑ UN1H2 . 30 Gal ❑ UN1A2 - 30 Gal ❑ 55 gal Labpacker ❑ Pump <br /> ❑ Nitrile Gloves , pair ❑ UN1 H2 - 20 Gal ❑ UN1A2 . 20 Gal ❑ 30 gal Labpacker ❑ WetlDry Vacuum <br /> ❑ Box , Rags ❑ UN1 H2 - 15 Gal ❑ UN1A2 - 5 Gal ❑ 20 gal Labpacker ❑ Pressure Washer <br /> ❑ Drum liner ❑ UN1H2 5 Gal ❑ UN1A2 - Overpack ❑ 10 gal Labpacker ❑ Sawzall _Blades <br /> ❑ Simple Green , gal ❑ UN1 H2 2 . 5 Gal ❑ 5 gal Labpacker ❑ Floor Buffer <br /> ❑ Bleach , gal ❑ UN1 H2 - Overpack Qty Metal CT Drums ❑ 8 ' Bulb drum ❑ Small Tools <br /> ❑ IPA, gal Qty Poly CT Drums ❑ UN1A1 - 55 Gal ❑ 4 ' Bulb drum ❑ Air Compressor <br /> ❑ Vermiculite, bag ❑ UN1 H1 - 55 Gal ❑ UN1A1 . 30 Gal ❑ 8' Bulb box ❑ Generator <br /> ❑ Preprinted Labels ❑ UN1H1 . 30 Gal ❑ UN1A1 - 20 Gal ❑ 4' Bulb box ❑ <br /> ❑ Resp. Cart . , Single ❑ UN1 H1 IF, 20 Gal ❑ UN1A1 - 10 Gal ❑ 4G PIH/Mercury ❑ <br /> ❑ Resp . Cart . , Combo ❑ UN1 H1 - 15 Gal Qty Tote ❑ Cubic yard box ❑ <br /> ❑ ❑ UN1 H1 - 5 Gal ❑ Tote - 275 Gal ❑ Super Sack ❑ <br /> By signing below as an authorized representative , you acknowledge the obligations Dresenteri in thic anraamant <br />