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0IQ4 <br /> RESIDUAL INFORMATAON Pl ,KK UP RJQUEST <br /> EQUILON TERMINALS AND PIPELINE <br /> Equilon Pipeline Company, P.O.Bax 2648 Houston,TX 77252-2648 Date: 1115107 <br /> This form must be filled out completely and all required analyses a#Wbod. FAX or&MAIL to the <br /> Residual Disposal Coordinator fbr characterization and transportation ofmatarial. <br /> am AREA PHONE FAX <br /> Jena Henry DR,IL,KY,LA,MS,NM,OK,TX,UT 7131241-0236 713/241-4119 <br /> Kyle Hunt CO, 1L,IN,KS, Ml,MO,MT, NE,O$OK,WY 713/241-4393 7131241-7159 <br /> Lisa ReaM AK,AZ,CA, CO,W,KS,NV,OR,WA 7131241-8894 713/241-7646 <br /> SITE I T <br /> Site Contact: Danns Dooley <br /> RagionlDistrict/Area: Western - -- Phone: 209 649-7176 Fax 209 835-5974 <br /> Facility Address: Thicy Pmp Station 25705 W.Patterson Pass Rd. <br /> City: Tracy - Stats: Ca. Zip: 95377 County: San!qaquin <br /> Location Number. <br /> Incident No.: Chop Code/SAP/Expsrrso1AFE 10011271 <br /> Send invoice to Name: _Domingo Nunez _-Address: 25705 W.Patterson Pass Rd. <br /> City: Tracy State: Ca. Zip: 95377 Telephone: 209 8348789 <br /> MatorW Description: Free Liquid ❑ Yes [0 No <br /> soil,rock with cmde oil - <br /> Process generating this residual:(Be specific) general clean up around pump pads <br /> Accumulation Date: 1115107 Sampling Date(if applicable) <br /> Type of container: Dnnft--Mow marry 1 Type: <br /> Drum ID Numbers: D1 <br /> Bins—How many Size: Volume in Bin <br /> Size: Volume in Bin <br /> Bin Supplied by: Bayviow <br /> Bulk pile Size (cubic yards) <br /> Other <br /> Any special requirements far drum pick-up? (Rusty,missing parts,lookers,eta.) NIA <br /> Comments1ocal Vendor suggestion: <br /> NIA <br /> Form filled out by: Dennis Dooley - _ - Date: <br /> Phone: 209 649-7176 Fou: <br /> E-Mdl Address: Company: <br /> NOTE: IF VERIFICATION FORM IS NOT RECEIVED BY SITE CONTACT WITHIN FIVE(S)DAYS, <br /> NOTIFY RESIDUAL DISPOSAL COORDINATOR BY PHONE. aara9roo <br />