4.0 Attachment 4 Bulk Pumping Notice - Blank.pdf

Call Date:

Bulk Pumpout Number:

Service Date: Time:

Activity Name: Base:

Building #: Pier:

Waste Type:

Approximate Quantity: Gallons

Site POC Primary: Phone # :

Site POC Secondary: Phone # :

Scheduler Contact Info Sheila Scott Phone #: 619-954-5396

Operations Manager: Jeff Peterson Phone #: 505-615-6729

Company Name: 0 Phone #: 0

POC: 0 Fax #: 0

TRUCK DOI: Yes ‐ □ ‐ No ‐ □

ANALYTICAL REVIEW: Yes ‐ □ ‐ No ‐ □

PUMPING/ MANIFEST PROCEDURES:

Building 3588 NBSD Building 788 NBC Building 2004 NBPL Building 333 NAB

Building 3588 NBSD Building 788 NBC Building 2004 NBPL Building 333 NAB

3. Contractor must transport waste as per the Shipping Papers:

Building 788 NBC OWTP

Building 788 NBC IWTP Building 3588 NBSD BOWTS Off Site Disposal Disposal Site:

Building 2004 NBPL BOWTS

Special instructions and additional information:

By signing this BPN, I agree that Pac Trans arrival and departure times are as printed below.

ACTIVITY REPRESENTATIVE (print & sign) DATE

ACTIVITY CONTACT PHONE NUMBER Pac Tans: Arrival time:

Pac Tans: Departure time:

Hazardous Waste Manifest:

NES ENVIRONMENTAL SERVICES

BULK PUMPING NOTICE:

1. Prior to pumping, Contractor must have vehicle inspected empty and pick up a Waste Acceptance Form (WAF)

2: Upon completion of pumping, Contractor must return to location indicated below for final inspection and shipping papers:

REQUESTOR INFORMATION

Contractor Information