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RESIDUAL INFORMATION PICK UP REQUEST, <br /> w <br /> E UILON TERMINALS AND PIPELINE' <br /> Equilon Pipeline Company. P.O.Box 2648 Houston,TX 77252-2648 Date: V21/08 <br /> This form must be filled out completely and all required analyses attached. FAX or E-MAIL to the <br /> Residual Disposal Coordinator for characterization and transportation of material.. <br /> DSC AREA - PHONE FAX <br /> Jew Healy. DE,IL,KY,LA,ACLS.NM,OK,TX,UT 713/241-0236 7131241-4119 � <br /> Kyle Hunt CO, IL,IN,KS, b%MO,MT. NE,OH,OK,WY 71312414395 7131241-7159 <br /> Lisa Reaves AK,AZ,CA, CO.Hl,KS,NV,OR.WA 7131241-8894 7131241-7646 <br /> SITE INFORIVIATi<N G <br /> E Site Contact: Dennis Dooley <br /> f 114on/District/Area: Western Phone: 209 649-7.176 Fax: 209 835-5974 <br /> Facility Address: Tracy Pump Station 25705 W.Patterson Pass Rd. , <br /> City: Tracy State: Ca. Zip: 95377 County: :San Joaquin <br /> Location Number: <br /> Incident No.:- Charge Code/SAP/Expense/AFE .- 10098255 <br /> ' Send-invoice to Name: o Nunez Address: 25705 W.Patterson Pass Rd. i <br /> City: Tracy State: Ca. Zip: 95377 Telephone: 209 834-8789 . <br /> Material Description: Free Liquid Yes ® No <br /> diapers,oily debris <br /> Process generating this residual: (Be specific) clean up from smart pig run <br /> C <br /> Accumulation Date: ..5/14/08- _ _ _ : _ 'Sampling Date(if applicable) <br /> Type of container: Drums—How many -2 Type: <br /> f <br /> Drum IDNumbers: DI-D2 <br /> Bins—How many Size: Volume in Bin <br /> Size: Volume in Bin F <br /> Bin Supplied by: Bayview <br /> Bulls pile Size (cubic yards) <br /> Other <br /> F <br /> Any special requirements for drum pick-up? (Rusty,missing parts,leakers,etc.) N/A <br /> i <br /> Commeuts/Local Vendor Suggestion: 1 <br /> N/A <br /> Form filled out by: Dennis Dooley - Date: <br /> Phone: 209 649-7176 Fax: <br /> E-Mail Address: Company: <br /> 1, NOTE: IF VERIFICATION FORM IS NOT RECEIVED BY SITE CONTACT WITHIN FIVE(5)DAYS, <br /> NOTIFY RESIDUAL DISPOSAL COORDINATOR BY PHONE. 09W/00 <br /> �I <br />