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SERVICE AGREEMENT <br /> Aft21An <br /> Great Oaks Boulevard <br /> � i■ s ■ s ALMOM w i <br /> w ■ . ■ . a Al . . r. w ■ v San Jose , CA 95119 <br /> M i i� ANNE r � AW 1 M <br /> Hazardous Waste Removal, Inc. Phone : (408) 363-3678 <br /> Fax: (408) 624-9335 <br /> Contractor's License No . 992495 <br /> Site Information <br /> Customer: t (. , A l' i" i `� .� ,61 l i i '1 �. �� T R� �) �'1 Service Date : <br /> Site Address : t <br /> City , State, and Zip ] Project Number : r> t <br /> Contact I <br /> Phone Number: 4 <br /> Scope of Work <br /> Q <br /> Labor Project Notes <br /> Name Start Arrive Depart End <br /> t <br /> Customer requests All Clean to submit <br /> copy of manifest(s) to DTSC, <br /> it <br /> i <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 ❑ UN1A2 . 55 Gal ❑ UN1G - 55 Gal ❑ HEPA Vacuum <br /> ❑ PPE - Level C ❑ UN1H2 - 30 Gal ❑ UN1A2 - 30 Gal ❑ 55 gal Labpacker ❑ Pump <br /> ❑ Nitrile Gloves , pair ❑ UN1H2 - 20 Gal ❑ UN1A2 - 20 Gal ❑ 30 gal Labpacker ❑ Wet/Dry Vacuum <br /> j ❑ Box , Rags ❑ UN1H2 - 15 Gal ❑ UN1A2 . 5 Gal ❑ 20 gal Labpacker ❑ Pressure Washer <br /> ❑ Drum liner ❑ UN11-12 - 5 Gal ❑ UN1A2 - Overpack ❑ 10 gal Labpacker ❑ Sawzall _Blades <br /> ❑ Simple Green , gal ❑ UN11-12 - 2 . 5 Gal ❑ 5 gal Labpacker ❑ Floor Buffer <br /> ❑ Bleach , gal ❑ LIN1 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 , ba UN1H1 - 55 Gal UN1A1 - 30 Gal ❑ 8' Bulb box ❑ Generator <br /> 9 ❑ ❑ <br /> ❑ Preprinted Labels ❑ UN1H1 - 30 Gal ❑ UN1A1 - 20 Gal ❑ 4' Bulb box ❑ <br /> ❑ Resp . Cart . , Single ❑ UN1H1 - 20 Gal F ] UN1A1 PIH/Mercury UN1A1 - 10 Gal ❑ y ❑ <br /> ❑ Resp . Cart , , Combo ❑ UN1 H1 - 15 Gal Qty Tote ❑ Cubic yard box ❑ <br /> El ❑ UN1H1 - 5 Gal E] Tote - 275 Gal ❑ Super Sack El <br /> _ • _ __ � _ _ L . 1 . . . . +ho nhlino+ inne nrcmnfarl in this anraamant <br />