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Work Order <br /> �� 1210 Elko Drive 2010 Mission Rood 265 Riggs Avenue 13722 Cormenita Road 6137 Edith Blvd. NE S11 Highway 213 work order # <br /> ACTSunnyvale, CA 94089 Escondido, CA 92029 Meaed, [A 95341 Santa Fe Springs, CA 90610 Alhuquelque, NM 87107 Chaparral, NM 88081 Proposal # <br /> 408 548-5050 P 760 489-5600 P 209 7224228 P 714 545-2191 P 505 349-5250 P 575 8240164 P Date <br /> 408 548-5052 F 760 489-5625 F 209 7228228 F 714 545-2287 F SOS 344-7986 F $7S 824 0208 F Acct. sales Manager LID WI <br /> Customer InformationService Request <br /> Name: eW-490,, kSF LTLr III— <br /> Address: 15700 RMIlil AVettue Description: ._..........................._.........._.._ ..._... .............._.......... ........................... <br /> _._.... <br /> Latl"lop, CA 45330 <br /> EPA ID # CALD00216M .. ............. .. ............... ......... <br /> Main Contact: 6 - 55 - DM - F1l - <br /> _r -cay - ri 0`i2E�i9f=151779 . <br /> Phone: 1 =-'pryg :Pl$!F! _._ r - <br /> Second <br /> ... .. 65.-..I,( A ... >900 &E AL511AVIiVGS-UA7H,DE8R15 - <br /> Phone : aryContact: 070A no ,r ,. -- - DEBRIS . . ...... <br /> Phone : <br /> 3 ,. . ._ . <br /> _ . <br /> Materials and Equipment <br /> t _ . ..... . <br /> New Reconditioned — "'-'-""' ------ - ---- - ' <br /> .....__.. :.:....... .. _...._.._...........L'4+,4-. . ..... <br /> Supplies <br /> Metal Poly Fiber Metal Poly Fiber - - <br /> ..___ ............... _......... ............. <br /> 5-gallon overpack : -- - <br /> 55-gallon closed top ������������- - .......... ...... . . . ._.._ <br /> 55-gallon open top <br /> 30-gallon closedtop i <br /> ..._.._......._.;...._.......__..}......_. _. ...._....... .. ..............................._............... ................_...._. <br /> 30-gallon open top ......................................... <br /> . ..._....... <br /> 20-gallon closed top <br /> .. _.....__- Services <br /> ............... <br /> 20-gallon open top I <br /> "" - --- -- Disposal Services: <br /> 15-gallon closed top Qualntity Containir Size Profile #/WasteT a Shi <br /> -- -- ....... - .... yp ppmgDocumene # Treat_ment FaciliTy <br /> [ 5-gallon open topLFF <br /> t� lG <br /> 10-gallon closed top — / - - - <br /> 10-gallon open top . . .... ....... .-� .,, .... .... <br /> .. . <br /> _ .. .... `� S � zi .Y2ZZS�Sj v4rJ` . <br /> 5- gallon closed top . . ...... <br /> MTube <br /> open top . .. _ ....... _ .. . . ...._.. <br /> ...... ._ . <br /> ......... . . . ._.._. <br /> opentop .._..._. . . . ..._..... ! _ . . ...... . . . . ..... <br /> ging .......... . ....... . .......... ................ <br /> nYate . . ...... ... ... . ........... ......... . .. <br /> ....,._ - . .......... t...... <br /> .... ..... .......... <br /> rd Box . ............... .. ............ .. . . ....... .; <br /> < . . ....... .... .. .. ........ ' <br /> ube Drum ,....... . . . ............. ........,............ . . . . . <br /> ubeDrum ...._..... .................. . . . ................... <br /> PackingMaterials # Transportation Services : <br /> Vermiculite, Bag _ Number of Containers Facility/Destination <br /> 04 <br /> Clay Absorbent, Bag <br /> Bubble Wrap, Roll "`.' ---- �-- . . . <br /> Bubble Wrap Bags, Box ""' - -- ... .. <br /> ......... . .. .. .-.. . . . .... . '>..._ _ <br /> Drum Liners .. - ..... .. .... . ..._.................................................. <br /> Pallet . . ........ . . ......... ...... . . .. . . -­ +r <br /> ......._........ -................-_ <br /> SuperSack <br /> _._.........__ .............-......................... <br /> Radioactive Waste Boxes . <br /> ............... abor:.. <br /> . <br /> .. <br /> ..... ___.............._................. <br /> Biological Waste Boxes ....... <br /> .. . . . ._................... . . ...................... L <br /> ed Biological Waste Bags Hours/Regular Hours/Overtime Service Provided <br /> Personal Protective Equipment ,Project Manger <br /> Level D ) Chemist __. ................ . .. .......... <br /> Level C � ��" � Technician : _. . . . . ._....... ._ . . ......... . . .. ...... <br /> Level B Dr v r 7 ....__ . ........._ <br /> Other Materials other: <br /> ........ . .. . ._....... ; . . . ...._._............................. <br /> # Notes: <br /> .............................................................. <br /> _..............._._............... ............._........ Customer Signature: Date: C� <br /> PRINT NAME : / ; � ,." G�� /G J <br />