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gEgpl <br /> I& LNMM&TIQN PICK UP REQUEAT. <br /> LON IMMUS MID PLPELM <br /> Egailon Pipeline Company, P.O.Box 2648 Houston,TX M52-2648 Datta: 611107 <br /> This form must be Shod out completely and all required analyses atffiched. FAX or E-MAIL to the <br /> Residua!Disposal Coordinator For eb wacterizabon and transportation of material. <br /> AREA PHONE FAX <br /> Jena Henry DB,IL,KY.LA,US.NM.OK,TX,ITT 713/241-0236 '1131241-4119 <br /> Kyle Hunt CO, ID,IN,KS, MI,MO,MT, NE,On OK,WY 713124I-4395 71312417159 <br /> Lisa Reaves AK,AZ,CA, CO,HL KS,NV,OR.WA 7131241-8894 71317.417646 <br /> SITE�11IFORMATIOIY <br /> Site Comet: Dennis Doale <br /> RegionlDistdct/Arma: Western Phone 209649-7176 Fax: 209835-5974 <br /> Facility Address: Tracy Pump Station 25705 W.Pattersom Pass Rd. <br /> City. They State: Ca. Zip: 95377 County: San Xoag04 -- <br /> Loc Won Number: <br /> Inddent No.: Cba%c Coda/SAP/Expense/AFE 10011274 <br /> Send kwoice to Name: Domingo Nunez Address: 25705 W.Patterson Pass Rd- <br /> City: <br /> dChy; State: Ca. Zip: 95377 Telephone: 209 834-8789 <br /> Material Description: Free Liquid ❑ Yes ® No <br /> ok debris <br /> Process Smaeraft this residual:(Be specific) cleanup finrm 24"check valve replacement <br /> Accumulation Data: 5/29/07 Sampling Date(if applicable) <br /> Type of container. Drums—How many Type: <br /> Drum ID Numbers: B»1 <br /> Bins—How many — _ Size: 2fyrd_ Volume in Bin <br /> Size: Volume in Bin <br /> Bin Supplied by: Bayview <br /> Bulk pile Size ____'___ (cubicyards) <br /> Other <br /> Any special requirements for drum picric-up? (fusty,missing parts.leakm,etc.) NIA <br /> Comments/Local Vendor Suggestion: <br /> N/A <br /> Form filled out by: DenaLs PInIg Date: <br /> Phone: . 209 649-7176 Fax: <br /> E-Mail Address: Company: <br /> NOTE: IF VERIFICATION FORM IS NOT RECEIVED BY SITE CONTACT WITEDN FIVE(5)DAYS, <br /> NOTIFY RESIDUAL DISPOSAL COORDINATOR BY PHONE. os��uo <br />