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i SERVICE AGREEMENT 21 Great Oaks Boulevard so • IF / � • L O /S w • M mw ~� mwr ,rM d � w San Jose , CA 95119 "wow Hazardous Waste Removal, Inc. Phone : (408) 363- 3678 1 Fax : (408 ) 624-9335 1 Contractor's License No . 992495 Site Information Customer: "1 ' n i 1 l`) _� l i F Service Date: c: r it- ,fit f r" f7 t'J ,� ;, r. � . S k �`� I 1 � - � c-�/ Site Address : I LJ el Ir ( i City, State , and Zip ? �� Project Number: Contact: Ji' Phone Number: Scope of Work `` @ 1 i Labor Project Notes Name Start Arrive Depart End Customer requests All Clean to submit copy of manifest(s) to DTSC . Supplies / Equipment Qty supplies Qty Poly OT Drums Qty Metal OT Drums Qty Fiber Drum/Boxes Qty Equipment ❑ PPE - Level D UN1H2 - 55 Gal ❑ UN1A2 - 55 Gal ❑ UN1G - 55 Gal F'] HEPA Vacuum PPE - Level C UN11-12 - 30 Gal UN1A2 - 30 Gal ❑ 55 gal Labpacker ❑ Pump Nitrile Gloves , pair ❑ UN11-12 - 20 Gal ❑ UN1A2 - 20 Gal ❑ 30 gal Labpacker ❑ Wet/Dry Vacuum ❑ Box , Rags ❑ UN1H2 . 15 Gal ❑ UN1A2 - 5 Gal 20 gal Labpacker ❑ Pressure Washer ❑ Drum liner F�] UN11-12 - 5 Gal ❑ UN1A2 - Overpack 10 gal Labpacker ❑ Sawzall _Blades ❑ Simple Green , gal LIN 1H2 - 2 . 5 Gal 5 gal Labpacker ❑ Floor Buffer ❑ Bleach , gal ❑ UN11-12 - Overpack Qty Metal CT Drums ❑ 8 ' Bulb drum ❑ Small Tools ❑ IPA, gal Qty Poly CT Drums ❑ UN1A1 - 55 Gal ❑ 4 ' Bulb drum F] Air Compressor ❑ Vermiculite , bag ❑ UN11-11 - 55 Gal ❑ UN1A1 30 Gal ❑ 8' Bulb box ❑ Generator ❑ Preprinted Labels UN1H1 - 30 Gal ❑ UN1A1 . 20 Gal ❑ 4' Bulb box ❑ ❑ Resp . Cart . , Single ❑ UN11-11 - 20 Gal UN1A1 - 10 Gal 4G PIH/Mercury ❑ Resp . Cart. , Combo ❑ UN1H1 - 15 Gal Qty Tote Cubic yard box ❑ UN1H1 - 5 Gal ❑ Tote - 275 Gal ❑ Super Sack ❑ Q„ oinninn hnIAM oc on nnthnri7orl rAnrocantativa vnu arknnwlarina tha nhlinations presented in this aareement .