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i <br /> WASTE PICK IIP REQUEST <br /> EMIL, DI5MIBUTION AND PIPE INE <br />' To: Sharon Blanton P.O. Box 4848 <br /> Waste Disposal Coordinator Anaheim, CA 92803 <br />' Shell Oil Company Phone: 714-520-3312 <br /> Fax: 714-520-3570 <br />' This form must be filled out completely and all analyses <br /> attached. Mail or FAX to the Waste Disposal Coordinator for <br /> characterization and transportation of material. <br /> Do you have a special plc uo .request? Yes No <br /> If yes, srec�fy Date: 1Z Zo Time: _ S : 00 A-AA <br /> Is the site open? Yes o <br /> If no, is it locked? Yes No <br /> Is this an operating service statin ? Yes No 'Le <br /> � <br /> If no, what is currently on site? <br /> Is the waste accessible? Yes No <br /> For bulk shipments , who will supply loader? <br />' Consultant Contractor Transporter <br />' CON.,=JAM OR CONTRAQ=M INFO MUION <br /> Company Name: <br /> Address- to S'a SAA v <br />' City: AV,[.tom State: Zi <br /> Contact: r tj ie - M.4TXJ rJ Phone: 2- U/o <br /> Fax: 4916 - <br /> District/Environmental Engineer: D''^j <br /> District: Phone: ( 0}6IC% Fax: <br />' SH= FACILITYIK0w Tj0N <br /> Facility Yla--61--ra <br /> - <br /> dress: W 7weZ-00 I <br /> City: State: Zip: <br />' County: ,* <br /> WIC Number: 2zC(- 7,1?0CT/DT: <br /> �.+p■no9rsol9s <br />�I <br />