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Work Order <br /> 1210 E1ka Orin 2010 Mission Rood 265 Riggs Avenue 13722(ormenita Road 6137 Edith Blvd.NE 511 Highway 213 work order# <br /> • Sunnyvale,EA 94089 Escondido,(A 92029 Merced,CA 95341 Sanru Fe Springs,(A 90670 Albuquerque,NM 87107 (hoporrol,N98808' Proposal# <br /> ACT` 408 548-5050 P 760 489.5600 P 209 722.4228 P 714 545.2191 P 505 349.5250 P 575 824-0164 P Date 23-FE&I g <br /> enuiro 408 548-5052 F 760 489.5625 F 209 722.8228 F 714 545.2287 F 505 344.1986 F 575 824-0208 F Acct.Sales Manager Pat Fioret <br /> 1 <br /> Customer Information _Service Request <br /> Name: Me nteca Unified &AuxA NzL(fi anteca FK§ <br /> Address: 4W E. Yte3e[4hite Ave Description: ..................... ...... ......... <br /> Ma <br /> escription: .....................Ma rteca, CA 95336 --..............._....._._._.._.___._...__.__.__..__._.____.__._......................_..._._.................._. <br /> EPAID# CALflpO' M59 ..._.....................................-'' '-' -- _._......_.__..._..................._------- <br /> Main Contact: Wornbady Wright 29S4S&OUO2- - -11310ViPsTE-PATH-HEALTHIMSE-ACT2t1739 <br /> Phone: <br /> 2-EA-ft mural Protad%%Equlpm ant-La*D <br /> Secondary Contact: 220-EA-FW dr EnargyRacowryFa■-8% <br /> Phone: <br /> PO# P01MIT76 <br /> Materials and Equipment .--....__...._.__._—.-'-'-'-.—•-'---•-•-----...-_-- --'—._..._.__.»....._._._.—..__._ <br /> New Reconditioned --""""—"'"'-"'—""-' ----•—•-------�_....._.__.__ �,,,,_ <br /> Supplies <br /> Metal Poly Fiber Metal Poly Fiber _ <br /> 85-gallon overpack - <br /> 55-gallon closed top _---- ----------___ .__ .. .. ___ __ <br /> 55-gallon open top <br /> 30-gallon closed closed top <br /> 30-gallon open top <br /> 20-gallon closed top <br /> ....... __.__}_.»_._».„___. Services <br /> 20-gallon open top Disposal Services: <br /> 15 gallon closed top ! I I Quantity Container Size Profile#/Waste Type Shipping Document# Treatment Facility <br /> 15-gallon open top <br /> _.._ t 1._. ._ . __ <br /> gallon closed top ' <br /> gallon open top ! i — <br /> _ _._._.._..s............... <br /> 5-gallon closed top ? , <br /> , <br /> i <br /> 5-gallon open top <br /> 1-gallon open top <br /> PIH Packaging ' 1 ---- i - — - -- --- --�---- <br /> 275-gallon tate <br /> Cubic Yard Box <br /> v <br /> Oft Light Tube Drum I <br /> ................... —... ....__..._....- <br /> 8ft Light Tube Drum , <br /> Packing Materials # Transportation Services: <br /> Vermiculite,Bag Number of Containers Facility/destination <br /> Clay Absorbent. Bag ---»— _—_ <br /> ...................._............ ......--....................-...............-...-n..............._....................._....................__._...-- ........... _-•_— ___....._.............. <br /> Bubble Wrap, Roll <br /> Bubble Wrap Bags,Box ...»..-......._.-,-._._--,-.- ............_._,_...,..,....................... <br /> .._....._._._._.__.__._.._....__._...._._..._._..,.............. <br /> Drum Liners <br /> ............... _ __ ... •-------- <br /> Pallet "�'(. ._....._._—.--------'--•-•—•-• -._._._._. <br /> ......_.......----.... <br /> SuperSack Notes: <br /> Radioactive Waste Boxes <br /> Biological Waste Boxes <br /> -^ <br /> Red Biological Waste Bags —_--- Labor: Hours/Regular Hours/overtime Service Provided <br /> Personal Protective Equipment # Project Martgar <br /> Level D TacChemist 7 <br /> ---- <br /> Ai <br /> Leve!C Techni <br /> Leve! B <br /> Driver <br /> Other: V <br /> I Other Materials # Notes: <br /> n <br /> Customer Signature: -. . FL'! ✓ Date: <br /> PRINT NAME; <br />