TE__1_LOT_1_SERVICE_ORDER_NON_RECURRING_FORM_9-6-2018.pdf

TE # 1 NON RECURRING SERVICE REQUEST FORM

REQUEST FOR REFUSE CONTAINER FORM

Installation: Building# POC Name: Cardholder (CH) Name: N/A Authorizing Official:

Title: Phone: Phone:

Phone: Fax No.: Email Address:

Fax No.: GPC Number:

Expiration Date:

DPW Reimbursable Credit Card Request Delivery Order #

Date of Request: Delivery Date/Time: Removal Date:

Service Required: (check all that applies – use the lock icon)

As Required Pick-Up Additional Pick-Up Clean and Sanitize

Remove Container Deliver Container Others

Special Instructions:

CONTAINER TYPE

QUANTITY AND SIZE: ea 8 Cubic Yard dumpster ea 40 Cubic Yard Rolloff

TYPE OF WASTE

Refuse Metal Green waste Construction Sharp/Medical Cardboard Wood Concrete

DPW USE ONLY (For Official Use Only)

CLIN DISCRIPTION UOI U/P

0005AA 8 Cubic Rent EA

0005AB Addl Days DA

0005AC Addl Disp EA

0006AA Rolloff EA

0006AB Addl Days DA

0006AC Addl Disp EA

0007 MEDWAS EA