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Work Order <br /> s+ a.` 1210 Elk,Olive 2010 Mission Road 265 Riggs Avenue 13722 Calmenito Road 6137 Edith Blvd.NE 511 Highway 213 Work Order# <br /> -:. Sunnyvale,CA 94089 Escondido,CA 92029 Merced,CA 95341 Santa Fe Springs,CA 90670 Albuquerque,NM 81107 Chopalrai,NM 88081 Proposal# 1279CA <br /> ACT` 406 548.5050 P 760 489-5600 P 209 722.4228 P 714 545-2191 P 505 349-5250 P 575 824.0164 P Date <br /> enviro 408 548.5052 F 760 489-5625 F 209 722-8226 F 714 545.2287 F 505 344.7986 F 575 824-0208 f Acct.sales Manager Pat Fbrtale <br /> Page I CO <br /> Customer Information Service Request <br /> Name: Manteca Uriified Scr>g IM.(Monbca 119i1 <br /> Address: Description, ...___-._...�.«._...._..._.._«._.«.««__....._.-«_._.«_.._.....«._...«.«-..._--..-._..._.«_._...-_-_..........-w-.__._.«_..___ <br /> 4w E Yo tnitu Ave <br /> Man"ca, CAI_— <br /> ...... <br /> ._...-'-'--.............................--''---'-- ----'---- - -- - --•-•-- - - '-' ._._..... <br /> EPA tD# QALOM <br /> Allain Contact: .......-15...`..........-.810.WI�ST1E..RATH-HP�THVIfIBE-AC7�0735 <br /> lCrrrbertyYllrigtrt �, 0 ......._......_...._..._....._...._._._...._...__...__._._...._...._....._....__.._._......_........_..._...__..................._..............__. <br /> Phone: 2-EA-Peesortal PratedKe Equipment-Letiel 1) ..«..._.-._.--.. <br /> Secondary Contact: <br /> Phone: .................««.«._._..-..._._...«.___.__._....--.._._.---._..-_ _..._. <br /> PC# P017-02744 <br /> Materials and Equipment <br /> Supplies New Reconditioned -- --'-'------------------------'------- --'—' - -- -- <br /> Metal I Poly FiberMetal Poly I Fiber <br /> 85-gallon overpack <br /> 55-9allon closed top <br /> 55-gallon open top ; ; --•--•-•----•-•-•---..__..._...._._........_,_..._..,_. ._ »..__«._ __. <br /> 30-gallon closed top j <br /> - <br /> 30-gallon open top — ----- - <br /> _ <br /> 20-gallon closed top I ; i01011 <br /> ..................._.. ..__._._.._._..._._._._._._.,-_.-._;.«,«._......_ Services <br /> 20 gallon open top Disposal Services: <br /> l5 gallon closed top Quantity Container Size Profile#/Waste Type Shipping Document# Treatment Facility <br /> 15-gallon open top <br /> allon closed top - <br /> k,gallon open top <br /> _— <br /> 5-gallon closed top <br /> 5-gallon open top ` ! <br /> I-gallon open top : <br /> PIH Packaging <br /> 275-gallon tote <br /> CubicYard Bax ----•-•-----•--•-- -.__..-,_.._._.._,--._...__.-,..__... <br /> 4ft Light Tube Drum <br /> ---.._._..._...;-_--....... ..._____...._._..___...._a.—._._._._c..__._._.. ...-....__._..__.»-...........................«....».»..«..........-....._._-----_._..._--............. _............._._—.._._..------------- --•—•—----------------- <br /> 8ft Light Tube Drum <br /> Packing Materials # Transportation Services: <br /> Vermiculite, Bag Number of Containers Facility/Destination <br /> Clay Absorbent,Bag <br /> _ . ID <br /> ..._-......_.._._._..__.... _ ........_-...:................................_...«._._... .........__.._._._...._....._.__...-'--'--'-'Bubble Wrap,Roll <br /> ............_......_.._...«._.«. _—._Bubble Wrap Bags, Box __ _.-.---.._._.. ...........Drum Liners <br /> Pallet <br /> SuperSack otes:Radioactive Waste BoxesBiological Waste Boxes <br /> Red Biological Waste Bags Labor: Hours/Regular Hours/Overtime Service Provided <br /> Personal Protective Equipment # Protect Manger .--._._._._.......----------._.—_._._._.._._._... ._.—._. _ .. _...Level Dhemi.._ •--_..__._._._..._._..........LevelCechni.............--'-•-•..._........_._.__ Driver ' <br /> L P el B -- .._.._. .. _... _...... <br /> Other: ' *-•-•---•-•-•-' <br /> Other Materials # Notes: <br /> ............ n i <br /> __.__.__..__..,_ __....... Customer Signature:t ` I , J <br /> PRINT NAME: 1-0 �n� r •-r,� <br /> 7 <br />