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Work Order <br /> -��� 1210 Elko Drive 2010 Mi'ion Rood 265 Riggs Avenue 13722 Cormenito Road 6137 Edith BWd-NE Sll Highway 213 Work order# „ <br /> •: Sunnyvale,CA 94089 Escondido,CA 92029 Merced,CA 95341 Santa Fe Springs,(A 90670 ARnpuerque,NM 87107 Chaparral,NM 88081 .Proposer a - <br /> ACTe 408 548-SOSO P 760 489.5600 P 209 722-4228 P 714 S4S-2191 P 505 349-5250 P 575 824-0164 F Date <br /> enc:rro 408 548.5052 F 760489-5625 F 209 722-8228 F 714545.2281 F 505 344-7986 F 575 824.0208 F A=t.Sales Manager <br /> '` N4aRxera <br /> Customer Information Service Request <br /> Name: P�a�sc�asFic e t inor <br /> Address:4¢W Fremilord Street Description: ._-_._-_—_. .._____...._.. <br /> oto , CA 96211 5 ..... <br /> EPA ID# Com- -- t58li.fua 1SSr&+'_a^4 '41'tg7.a. yx*utltt4±b:..iL Rtt4"r� .... <br /> Main Contact: Katheirine, Ander m209.37C5 ?il i.&Wi Ind dab bods dni <br /> . _._.. _ —..... .._..__—...__._ i <br /> Phone: # 65ALKA INE CO-A.CLEANER 07013771 0-=42 <br /> .. <br /> __. <br /> oontlary Contact: <br /> Ph <br /> Phone: ..__.�_ ..tt.4-��^.4tb�..{�.§L"✓1.'}�.a!t4�-�,s6$-t?._......_____...........__.—. i <br /> P0# 56- -UNFVERSr-lt.AFt't sY!s-ABC_ACT726o6 <br /> Materials and Equipment �'F=LU��Ayq T3- - -- j <br /> New Reconditioned <br /> _-_'` 7Y�'$-d.!T:f aiP#4Lt4^X160f 6?TiSS3_ <br /> Supplies Metal Poly Fiber Metal Poly Fiber Ctdm$-'uttATF'' °ri93aFP <br /> 4E3tEtE4a Eii94 LF i$�21F42 <br /> 85-gallon overpack ( <br /> —`i ,�p - " <br /> iii dk <br /> s� a"r �p,e.m-0tivt <br /> 55-gallon closed topI � <br /> 55-gallon open top <br /> , (.YBBSbEY.�"siRGLffi.�t��+Ft.PE"s-"��L'•�'t <br /> 30-gallon closed top j ! � �- S-EA-Dnm i.klss <br /> 30-gallon open top <br /> 20-gallon closed top ! — <br /> _—.4_._._.._1.__... ...;.._—' <br /> 20-gallon open top ! j <br /> Disposal Services: <br /> 15•gaflon closed top DuanI Container Size Profile#/Waste T <br /> _._s____._�._ .__.lH ype Shipping Document# Treatment Facility i <br /> 15-gallon open top _- I r�-'-- I <br /> 1c)-gallon closed top f --------- _.. -. y .. . <br /> i l <br /> 10-gallon open top <br /> 5-gallon closed top <br /> 5-gallon open to i— --'-- ---'---" <br /> 7•gallon open top ! ' i .—r.—..___._._.___..._.r_._.�_...___• �_._.___—_. . <br /> PIH Packaging ' <br /> 275-gallon tote <br /> Cubic Yard Box <br /> Oft Light Tube Drum i - <br /> 8ft Light Tube Drum •.__._.__.._..__...,..... ._._._.-._._. <br /> i ! <br /> Packing Materials # Transportation Services: <br /> Vermiculite,Bag T— Number of Comainare Fadnn//Destinatlen <br /> Clay Absorbent,Bag <br /> _.-------- <br /> Bubble Wrap,ROTI - � - <br /> __ <br /> Bubble Wrap Bags, Box j <br /> Drum Liners <br /> Pallet ---�---� ------ <br /> SuperSack <br /> Radioactive Waste Boxes "-- <br /> Biological Waste Boxes —___ __'__ ENVIRONMENTAL FA <br /> Red Biological Waste Bagsj Latton: Hours/Regular r'1'It7 i Service Provided <br /> Personal Protective Equipment # Project Manger <br /> Levet D .....� Chemist _ <br /> Level C - T•Mmmn "� <br /> Level6 _......._....... <br /> i Other Materials # Other: <br /> tastes: <br /> Customer slgrjdr :,../ Day, <br /> �� y> <br /> PRINT NAME: <br />