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HomeOffice: 6mi 75th Annum i4 <br />LMI n ' 8`Z 85339 <br />2010 Mission Road <br />boned°. (0 92029 <br />265 Riggs Arrow <br />Pawed, (A 95341 <br />600 lowa Street <br />kdi'mk CA 91313 <br />4 Wayne Court Building 9 <br />Sacramento, CA 95879 <br />13722 Emmenita Road <br />Santa ft Springs, EA 90670 <br />6137 Edith Bled NE <br />Alb""r"'""1" <br />208 Munay Road SE <br />Albuquerque, NM 87105 <br />511 Highway 213 <br />Chaparral, NM 88081 <br />136005r Ambler Road <br />Clackamas, OR 97015 <br />WORK ORDER <br />Work Order I <br />Proposal if 256658 Date <br />Acct. Salo, Manager 12-AUG-20 <br />;maw labrart <br />-dry. <br />AC <br />ts"dr., <br />Cal Pin) <br />_ 967 Mabory Road <br />A% 9a:01801%0956133 p <br />408 84.5082 F <br />Customer Information - Service Service Request <br />Name: <br />Address: Mizkan America Inc (formerly R&B Foot.!:- <br />1400 Waterloo Rd <br />Stockton, CA 95205 <br />EPA ID # CAL000415264 Main Contact: <br />Phone: Dwayne Roberts 209-761-6800 <br />Secondary Contact: <br />Phone: <br />PO # <br />Description: . <br />WNW MWE-IGHT-ALLOWED PER PICKUP-IS 2i198-POUNDS- <br />. <br />- HR - Labor - Class A Driver <br />1-ersonatProtective Equipment-- Levet-D <br />1 - EA- Fuel & Energy Recovery Fee <br />1104 Pa& <br />Materials and Equipment <br />Supplies New Reconditioned <br />Metal I Poly I Fiber Metal I Poly I Fiber <br />85-gallon overpack <br />55-gallon closed top <br />55-gallon open top <br />30-gallon closed top <br />-gallon open top lli30 <br />rAto <br /> <br />20-gallon closed top <br />20-gallon open top <br />15-gallon closed top Quantityl Ci Tolir4W Treatment Facility <br />15-gallon open top <br />-remtsFer n <br />WV/ / COWS. <br />Itpetite • <br />10-gallon closed top <br />10-gallon open top <br />5- gallon closed top <br />5-gallon open top <br />1-gallon open top <br />PIH Packaging <br />275-gallon tote <br />Cubic Yard Box <br />4ft Light Tube Drum <br />alt Light Tube Drum <br />Packing Materials # Transportation Services: <br />Vermiculite, Bag Number of Containers I Facility/Destination <br />Clay Absorbent, Bag <br />Bubble Wrap, Roll <br />Bubble Wrap Bags, Box <br />Drum Liners <br />Pallet <br />SuperSack Notes: <br />Radioactive Waste Boxes <br />Biological Waste Boxes <br />Red Biological Waste Bags Labor: I Hours/Regular I Hours/Overtime 1 Service Provided <br />Personal Protective Equipment # Project Manger <br />Chemist Level D i <br />Technician Level C <br />Driver /". , jy... <br />Other: <br />Level B <br />Other Materials # Notes: <br />Customer Signature: <br />C 4 60,1v._ Dat,,,, <br />PRINT NAME: .,.,,,, ____LAI c...). ( .. CDO\kACtO(\ <br />• <br />• <br />• <br />• <br />• <br />• <br />• <br />• <br />• <br />• <br />• <br />•