Laserfiche WebLink
6G A <br /> itEsyauAL jMQRMM0N.P1CK1& REQUEST <br /> EOUIWN YIBMINALS AN2XjEELI, N <br /> Bquilon Pipeline Company, P.O. Box 2648 Houston,TX 77252-2648 Date: 2/4108 <br /> This form must be filled out completely and all required anal.yses attached. FAX or E-MAIL to the <br /> Residual Disposal.Coordinator for characterization and transportation of material. <br /> DSC AREA PHONE FAX <br /> Jena Henry DB,1L,KY,LA,MS,NM,OK,TX.UT 713/241-0236 7131241-4119 <br /> Kyle Hunt CO, II,,IN,KS, MI,MO,MT, NB,OH,OK,WY 713/241-4393 713t241-7139 <br /> Lisa Reaves AK,AZy CA, 00,HI,KS,NV,OR,WA 7131241-8894 713/2AI 7646 <br /> SITE INFORMATION <br /> Site Contact: Dennis Dooley _ <br /> Region/District/Area: Western Phone: w 209 649-7176 Fax: 209 835-5974 <br /> Facility Address: Traw Pump Station 25705 W.Patterson Pass Rd. <br /> City: Tmry State: Ca. Zip: 95377 County: San Joaquin _ <br /> Location Number: <br /> Incident No.: Charge CoWSAP/Expense/AFE 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 /> Material Description: Free Liquid ❑ Yes ® No <br /> soil 4hTo jok debris <br /> Proms generating this residual:(Be specific) general clean up around pump station <br /> Accumulation Date: 211/08 Sampling Date(ff applicable) <br /> Type of container; Drums—How many 1 Type: <br /> Drum ID Numbers: D1 <br /> Bins--How many Size: Volume in Bin <br /> Size. Volume in Bin <br /> Biqa Supplied by: Baycrlew <br /> Bulk pile Size (cubic yards) <br /> Other <br /> Any special requirements for drum pick-up? (Rusty,missing parts,leakers,etc.) NIA <br /> CommenWl.mal Vendor Suggestion: <br /> N/A <br /> Form filled out by: Dennis Dooley Date: <br /> ,Phone: 209 649-7176 Fax: <br /> E-Mail Address: Company: <br /> NOTE: IF VERIFICATION FORM IS NOT RECEIVE])BY SITZ CONTACT WITHIN FIVE(5)DAYS, <br /> NOTIFY RBSIDUAL DISPOSAL COORDINATOR BY PHONE. 009100 <br />