Laserfiche WebLink
ACT <br />enviro <br />Home Office: <br />967 Mabury Road <br />San Jose, CA 95133 <br />408 548-5050 P <br />408 548-5052F <br />02125 75th Avenue 44 <br />Laveen, 07 85339 <br />2010 Mission Road <br />Escondido, CA 92029 <br />265 Riggs Avenue <br />Merced, CA 95341 <br />600 Iowa Street <br />Redlands, CA 92373 <br />4 Wayne Court, Building 9 <br />Sacramento, CA 95829 <br />13722 Carmenita Road <br />Santa Fe Springs, CA 90670 <br />6137 Edith Blvd WE <br />Albuquerque, NM 87107 <br />208 Murray Road SE <br />Albuquerque, NM 87105 <br />511 Highway 213 <br />Chaparral, NM 88081 <br />13600 SE Ambler Road <br />Clackamas, OR 97015 <br />010 <br />vs • is <br />Metal Poly Fiber Metal Poly I Fiber <br />Main Contact: <br />Phone: Denelle Rodriguez 6: <br />Secondary Contact: <br />Phone: <br />PO # <br />Materials and Equipment <br />EPA ID II NIA <br />WORK ORDER <br />Work Order # <br />Proposal # 2i3D265 <br />Date <br />Acct. Sales Manager <br />Jor, C3 Moran <br />Customer Information <br />Name: <br />Mitsubishi Chemical Advanced Materials Address: <br />3937 Imperial Way <br />Stockton, CA 95215 <br />Service Request Pap: <br />Description: <br />-1....155- DM- ' • <br />I - EA- Per D <br />-liftwitebr •—• <br />-EA- klenift„ <br />-EA-Fuel <br />New Reconditioned <br />55-gallon closed top <br />55-gallon open top <br />30-gallon closed top <br />30-gallon open top <br />20-gallon closed top <br />20-gallon open top <br />15-gallon closed top <br />15-gallon open top <br />10-gallon closed top <br />10-gallon open top <br />5- gallon closed top <br />5- gallon open top <br />1- gallon open top <br />PIH Packaging <br />275-gallon tote <br />Cubic Yard Box <br />4ft Light Tube Drum <br />81t Light Tube Drum <br />Packing Materials <br />Supplies <br />85-gallon overpack <br />Services <br />Disposal Services: <br />Container Size I Profile #/Waste Type Shipping Document # Treatment Facility <br />.,.. <br />7 ! i t• -.1.— i• .• ! <br />I 1 i ! ! i <br />! <br />; . . ! 1 : -i- ---i- <br />I 1 1 <br />1- <br /> <br />._.....,..• ..1 <br /> <br />I 1 . i 4 ! . 1 <br /> <br />. I 4- <br /> <br />i I ; ; <br />Transportation Services: <br />Quantity <br />Vermiculite, Bag <br />Clay Absorbent, Bag <br />Bubble Wrap, Roll <br />Bubble Wrap Bags, Box <br />Drum Liners <br />Pallet <br />SuperSack <br />Radioactive Waste Boxes <br />Biological Waste Boxes <br />Number of Containers I Facility/Destination <br />) <br />Notes: <br />Red Biological Waste Bags <br />Personal Protective Equipment <br />Labor: <br />Project Manger <br />Hours/Regular Hours/Overtime Service Provided <br />Level D <br />Level C <br />Level B <br />Other Materials <br />Chemist <br />—'--r- -. ! <br />Technician i 1 i <br />Driver .'. ' - , r <br />! <br /> Other: i <br /># Notes: <br />Customer Signature: , <br />PRINT NAME: \ <br />Date: <br />71/Zi/Vo / Id/4/ /2!