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VW, o r k fZ <br />0 <br />V xezE7 WlRiagsbeiuie 1210flkDDrive 2213 Mayers Avenue 2501 S.Garmy St., Suite 0 1 Work Order # CV01505 <br />Marled, CA 95341 Sunnyvale, CA 94089 haindido, CA 92029 Santa Ana, (A 92707 prop ... I O.WON20 10 <br />_3 209 722-4228 408 548-5050 760 4895600 714 545-2191 Dina <br />209 722-8278 408 548-5052 760 4895625 714 545-2287 lAccount Sams Manager. En'—n Ti -@{B& <br />Customer Information <br />Service Request <br />Name Intw=e Concrete Purnpinig, Inc <br />Address: 11180Vallejo ct <br />Rmdi Cmnp, CA 95231 <br />EPA to # CAL 000 285 188 <br />Main Contact: Myra Nablit, manispir <br />Phone 20-11i�3092 <br />Secondary Contact: <br />Phone: <br />PO# <br />Description: <br />Pedorm <br />Scheduled Pmts Walats Sevi�{s) <br />Pick IIn: <br />DeftyeT. ---- <br />------ . . ....... . . <br />Manifest and Generator Information <br />Pass <br />Fail <br />Pass Fail I Retain ID <br />Container information <br />Containers <br />No. Type <br />Total <br />Qvinw.111, <br />wei,hibrifol.m. <br />—Chlor <br />US DOT Description (include proper shipping name, Haz class and ID) <br />I;cn-'RCRA Hmxd= WaSt% Llqmd <br />(oily wd'35 <br />Manifest Number T, 744 Transporter 10 No I CAR 0()0 (Y70 540 <br />GeneratorEPAID NO. <br />CAL 000 3891320: '! - ' <br />Designated Facitty and iwidms Riva it Oil TrM99r, LLC <br />FarilityPhane# (209) 963-9181, <br />5300 Clans Rd <br />RiVq:rbm,-%. CA 95367 <br />USA EPA 10 # =T OW 190 816 <br />stat. 10 # <br />Disposal Services: <br />Transportation Services: <br />Manifest Number <br />plan. <br />QW, '[SOF <br />NurnberarConnari.irs <br />Facnitymoslioation <br />i 21 If,. <br />-4- - <br />ko- <br />New <br />�R"oo�dtjaj&d <br />Quenity Misc. Supply OescNption <br />SU Iles <br />Metal Poly fiber <br />f:,,.,I; <br />I Metal Poly Fiber <br />r <br />jba� <br />-- — ------- — <br />-------- <br />55-gation closed top <br />55 -gallon open top <br />30 -gallon closed top <br />30 -gallon open top <br />15 -gallon closed top <br />15 -gallon open top <br />r. Hours/Regular I Houraloverthn, ServiceProvided <br />5- gallon clerical top <br />Project <br />Fnj.Man,., <br />cchemiste <br />Technician j <br />Driver <br />Other: <br />275 -gallon tot <br />Cubic Yard Box <br />.... ... <br />4ftLight Tube Drum <br />Customer Signature: <br />Date: <br />Sit Light Tuba Drum <br />Vermiculite, Bag <br />Clsy�..,b�ent,Bag <br />PPE <br />1%, <br />