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Work Order <br /> T1210 Elka Ddve 2213 M.y...Avenue 165 Riggs Avenue 13722 Cortoenita Road 6137 Edith Blvd.NE 5111 Way 213 Work Order# <br /> Sunnyvale,CA 94089 Escondido,CA 92029 Merced,CA 95341 Santa Fe Springs,CA 90670 Albuquerque,NM 87107 (haparrol,NM 88081 Proposal# tb227 <br /> 408 548-5050 P 760 489-5600 P 209]22-4228 P 714 545-2191 P SOS 349-5250 P 575 824-D164 P Date 11-SEP-1 2 <br /> Ad ...dGemlmlrmvpea 408548-5052 F 7604895625 F 209721.8228 F 714545-2287 F 505344-7986 F 5758240208 F Acct.Sales Manager WanTrsfenit <br /> Customer Information Service Request Pas I <br /> Name: E oM Gi ralfla <br /> AddressMlll S.AIP{1DM Way Description:_-._—._._-....___.—._._._-_.._.-.-...._..._.._- <br /> 3kmftonr CA 96206, CA SSM ......................... <br /> EPA ID# M .M6 <br /> -- ----............. <br /> ..... <br /> Main ContactVIIIIIIIIII HelssII _2-EA_W(Wan ollqueraua Parlig Wn w ----------_--- <br /> Phone: 2914464n2 t-Lk-Fud&115bergyRecoy"I%a-8.6% <br /> Secondary Contact: <br /> Phone: <br /> PO# <br /> Materials and Equipment <br /> New Reconditioned -"-""'-- ------ -'-- -- ------ <br /> Supplies <br /> Metal Poly Fiher Metal Poly Fiber <br /> 85-gallon overpack - --__----- <br /> _._._...... :................ <br /> 55-gallon closed top <br /> .............. <br /> r <br /> 55-gallon open top <br /> --------- — _i ..... <br /> 30-gallon closed top i <br /> 30-gallon open top <br /> 20-gallon closed top 1 <br /> ---- F -- -----........... Services <br /> 20-gallon open top i j <br /> Disposal Services: <br /> 15-gallon closed top i ty Type Shipping Document# Treatment Facility <br /> 1 _ _ quant) ContainerSize Profile#/WasteT a <br /> 15-gallon open top <br /> .. Z 111 _ _ � f .--- <br /> c:_� <br /> . ......... <br /> 10-gallon closed top ; <br /> 10-gallon open top ' - <br /> ___. —_. <br /> 5-gallon closed top � ' � i �-� <br /> 5-gallon open top <br /> 1-gallon open top <br /> PIH Packaging <br /> 275-gallon tote I I <br /> ---- _.._ —: <br /> Cubic Yard Box �—�� <br /> 4ft Light Tube Drum I. I ---- --- -_- "��---- <br /> — <br /> ...__....._. . ......... _ .._._._._ .......... _............ ......... _ ..._._. <br /> 8ft Light Tube Drum <br /> Packing Materials # Transportation Services: <br /> Vermiculite,Bag Number of Containers Facility/Destination <br /> Clay Absorbent,Bag i <br /> Bubble Wrap,Roll <br /> Bubble Wrap Bags,Box <br /> Drum Liners <br /> Pallet <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 /> Level D Chemist <br /> Technician "7 <br /> Level ,trkr c.•S <br /> Level B .. .......... .. .. Driver J7X Ory <br /> y Z.5 <br /> Other: <br /> Other Materials # Notes: <br /> ...--'---------—............. <br /> ._... <br /> .........._._.............._................- Customer Signature: Date: <br /> _._..__—__.—.._._....._.......... <br /> . <br /> /e <br /> Y � <br /> PRINT NAME: tt° = �`. <br />