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ZFERGUSON <br /> Nobody m us than e do <br /> .... expecfz mare s° w_ ,,,_ ..._ ._. .... ..._..._ <br /> -: Ferguson Enterprises 1larerdous Waste;PldruP Request Bectroruc Order Form .. <br /> Form Instructions: <br /> Fill in the Gray Colored Boxes. Provide as much detail as possible. Email the completed form to: Fergusonretail@cleanharbamcom DoWtforget to Include the SDS and photos of the waste if available) <br /> Questions on this form: Contact Drew Hartsock at drew.hartsock@ferguson.com or 757-969-4725 <br /> V'2euson Location Number 321 Ferguson Contact Person Loialie Macasinag <br /> LOCATION STATE California Ferguson Contact Telephone (209)943-8387 <br /> E OF REQUEST 10/3/2018 Ferguson Contact Email Iie.Macasina .com <br /> Quantity CONTAINERTYPE Accumulation Start Date(Date <br /> Ferguson WASTE DESCRIPTION PROFILE NUMBER (How many pieces of the waste iters) (What kind of drum Is the waste In.pofy,steel,etc) Urdt of Measurement(Size of container) Identified) <br /> UPS Battery Park(PowerSonk) is I I I Plastic Case and Cover each <br /> Absorbertw/Hydraullc 011 3 Plastic Bag 12-16 Gallon 3 MIL(Not Full) 7/9/2018 <br /> Absorbent w/.Battery Add. - ,1 Plastic Bag 12-16 Gallon 3 MIL(Not Full) 9/10/2018 <br /> Disinfectant Cleaner :.I - Plastic Bag In a box' 25 Liter 6/17/2018 <br /> Paint Thinner(Empty) i Can - IQuart 9/13/2016 <br /> CellingTexture 2 Aerosol Can 14 oz 9/13/2018 <br /> Power Cleaner Degreaser 1 Plastic Bottle ' 1 Quart 9/14/2018 <br /> Multi-Purpose Ceramic rile Cement 3 Plastic Bucket 1 Gallon 8/25/2018 <br /> Odor Eliminator 2 Pfastic Bag 2 Liter 9/26/2018 <br /> (Battery)Acid Wash Water 2 Poly Plastic Drum <br /> 55 Gallon 9/26(2018 <br /> Absorbent w/(Battery)Acid Wash <br /> Water,PPE used to transfer the water - <br /> Waste:' I Poly Plastic Drum 20 Gallon 9/26/2018 <br /> Floor Stripper, ,'I Plastic Bag in a box 5 Galion 10/1/2018 <br /> AntiBac Foam Wash 5 Plastic Bottle 1 Liter - 10/17/2018 <br /> Carpet Protector 3 - - Plastic Bottie 1.Gallon - <br /> 10/17/2018 <br /> Dud Sealant I Plastic Bucket; - 1 Galion 10/18/2018 <br /> Thread Cutting Ol 1-' Plastic Bottle 1 Gallon 10/16/2018 <br /> American Standard Odor Barrier Y Plastic Bottle 10 oz 10/16/2018 <br /> PPE,Box,PaperTowel used to dean AS _ <br /> Odor Barrier spill. I1 Plastic Bag 1 Gallon 10/16/2018 <br /> Alkaline Duracell Batteries 50 Plastic Bag each 10/17/2018 <br /> Clean Harbors Container Code Container Type Cost per Item Number of Containers/items.Needed Special Notes <br /> DM55STL 55 Gallon Drum Reconditioned-DOT Rated $ 55.00 Hawaii Locations contact Drew Hartsock for pricing <br /> DM55POLY 55 Gallon Poly Drum-DOT Rated $ 75.00 Hawaii Locations contact Drew Hartsock for pricing <br /> DM20POLY 20 Gallon Poly Drum-DOT Rated $ 45.00 Hawaii Locations contact Drew Hartsock for pricing <br /> DM5POLY 5 Gallon Poly Pail-DOT Rated $ 16.00 Hawaii Locations contact Drew Hartsock for pricing <br /> VERMSORB Vermiculite Absorbent $ 19.00 - - Hawaii Locations contact Drew Hartsock for pricing <br /> BOX8 8 Foot Light Bulb Box $ 20.00 Hawaii Locations contact Drew Hartsock for pricing <br /> BOX4 4 Foot Light Bulb Box $ 15.00 Hawaii Locations contact Drew Hartsock for pricing <br />