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Work Order <br /> . r . 121D Elka Drive 2010 Mission Road 265 Riggs Avenue 13722 Carmenite Rood 6137 Edith Bbd.NE 511 Highway 213 Work Order# <br /> Sunayvale,CA 94084 Escondido,CA 92029 Merced,CA 95341 Santo Fe Springs,CA 90670 Albuquerque,NM 87107 Chaparlol,NM 88081 Proposal# 1 SM71 <br /> ACT` 408 54$3050 P 760489.5600 P 209 722.4228 P 714 545.2191 P 505 349.5250 F 575 824.0164 P Date 254NY B <br /> enviro 408 548.5052 F 760 489.5625 F 209 722.8228 f 714 545.2287 F 505 344.7986 f 575 824-0208 F Acct.Sales Manager Jas•Wbran <br /> Customer Information Service Request <br /> Name: ilblll ecs i iMSL-d School Qin Mcca <br /> Address: 40 L Yosemlae Ave escription: •_..»......................................._._. <br /> EPA i0GAL"128259 <br /> # .-__.__._._..__.�......_.._................_......._.......------- <br /> ---- _ <br /> Main Contact: )Cnv1 berfy Wright 2D9.65i-0960 4-38-DF-1*0 VWTE-PATH-HF- LTHWSE-ACT20 7'36 <br /> Phone: 4-EA-39 t3ellort Blohant dous Drurtts <br /> Secondary Contact: •"--•-�`�"Aa����"����4'"".��-�-•--•-----..__....._._..._.._._..„__.__.-.. <br /> Phone: _._ 420-EA.-Fua1 A Erwrgy Raeowry Foo-5% <br /> PO# !A tf7i'. <br /> Materials and Equipment — <br /> New Reconditioned - --------- <br /> - ------ --- - -------_ -_—--- -----—-- <br /> Supplies Metal Poly Fiber Metal Poly Fiber <br /> 85-gallon overpack <br /> .............. ......._-.a_.. ............... <br /> ..._... <br /> -- ---._._..._._..............._._.-.-_......__ -- -.-..-.--- <br /> 55-gallon closed top <br /> 55-gallon open top i <br /> —_........ <br /> 30-gallon closed top ; <br /> 30-gallon open top <br /> 20-gallon closed top <br /> ' Services <br /> 20 gallon open top - - - Disposal Services: <br /> 15-gation closed top Quantityl container Size Profile#/Waste Type Shipping Document# Ttaatnntit Facility <br /> 15-gallon open top i <br /> alion closed top <br /> Dili <br /> -------------- <br /> gallon open top I F <br /> 5-gallon closed top � - <br /> i <br /> 5-gallon open top i <br /> 1-gallas open tap - <br /> PIN Packaging ---- -- - - - - <br /> 275-gallon tote <br /> Cubic Yard BoxI ! I <br /> ; <br /> ........_...... <br /> 4tt Light Tube Drum ; <br /> aft Light Tube Drum ! <br /> Packing Materials # Transportation Services: <br /> Vermiculite,Bag Humber of Containers Facility/Destination <br /> Clay Absorbent,Bag <br /> Bubble Wrap,Roll <br /> Bubble Wrap Bags, Box <br /> Drum Liners <br /> ._._._.............._........................... ._...... -—-.......-............_._ . .._ <br /> Pallet �'�' ' _.--_.-�• -• ---•-------....._._._.___._.__..«.-......_._._......_---....... <br /> .............-............ <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 # Pr°jecit Manger <br /> Level D Chemist ? <br /> ........... <br /> Level C Sechn._..I-Z' <br /> . t- - - <br /> -- ----- .r.� <br /> Other: _.1..........._.__._._. . ! <br /> L el B _....._................_._ prlver <br /> PV <br /> Other Materials # Nates: <br /> -___—_--_ Customer Signature: ff Vr s J / pate; <br /> PRINT NAME: <br /> i �� <br />