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1�nmq( <br /> RF. uAL MFOMMTION PICKUP RLQUEST <br /> EUUII.ON TFSNiINALS AND PIPEL,IPM <br /> Equiloo Pipeline Company, P. 0.Box 2648 Housum,TX 77252-2648 Date: 10/30/07 <br /> This form must be filled out completely and all required analyses attached. FAX or E-MAIL.to the <br /> Residual Disposal Coordinator for chamewrization and transportation of material. <br /> B AREA PHONE FAX <br /> Tena Henry DE,lI.,KY,LA,MS,NM,OK,TX,UT 7131241.0236 7131241-4119 <br /> Kylo Hunt CO, IL,IN,KS;MI,MO,mr. NE,OH,or,WY 7131241.4395 713/241-7159 <br /> Lisa Reaves AK,AZ,CA, C4,W,KS,NV.OR,WA 71312414894 713/2417646 <br /> 117E INFORMT�Q1� <br /> Site Contac: Dennis Dooley <br /> Rg0on1DisWct/Arcw. Western Phone: 249649 7176 Fax: 209 835-5974 <br /> Facility Address: Tmy Pum Station 25705 W.Patterson,Pass Rd. <br /> City: Tracy State: Ca. Zip; 95377 County: SanJoaquin <br /> Location Number: <br /> Incident No.: Charge Code/SAAP1ExpenWjAFE 10011719 <br /> Send invoice to Name: Do o Nunez Address: 25705 W.Patterson Pass Rd. <br /> City: Tracy State: Ca. Zip: _95377 Telephone: 209 834-8789 <br /> Materia!Description: Free Liquid [1 Yes ® No <br /> oily debris <br /> process generating this residual:(Be specific) general valva and equipment clam up <br /> Accumulation Data: 10129107 Sampling Date(if applicable) . <br /> Type of container: Drums—How many _ Type: <br /> Drum ID Numbers: DI D2 <br /> Bins—How many Size: Volume in Bin <br /> Size: Volume in Bin <br /> Bin Supplied by: Bawiew <br /> Bulk pile Size (cubic yards) <br /> other <br /> Any special requirements for drum pickup? (Rusty,missing parts,lckcM etc.) NIA <br /> Comments/Local Vendor Suggestion: <br /> NIA <br /> Form filled out by: _Derws Dooley Dates <br /> Phone: 209 649-7176 Fax: <br /> E-Mail Address: Company: <br /> NOTE: IF VERIFICATION FORM IS NOT RECEIVED BY SITE CONTACT WITHIN FIVE(5)DAYS,M9100 <br /> NOTIFY RESIDUAL DISPOSAL COORDINATOR BY PHONE. <br />