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14t) I 'A <br /> HISED INEQgM&TI PICK UP RMUEU <br /> LQMM TERMINALS AND PIPELINE <br /> Equilon Pipeline Company, P. O.Box 2648 Houston,TX 77252-2648 Data: 1017108 <br /> This form must be filled out completely and all required analyses attached. FAX or MAIL to the <br /> Residual Disposal Coordinator for claaraater udOn and transportation of material. <br /> An AREA PHONE FAX <br /> Jona Henry DE,U.,KY,LA.MS,NM,0K,TX 0,CTI' 713/241-0236 7131241-4119 <br /> Kyle Hunt CO, IL,IN,KS, b%MO,MT, NE,OH.OK,WY 713/2414395 7131241-7159 <br /> Lisa heaves AK,AZ,CA, CO,Ifi,KS,NV,OR,WA 7131241-8894 713/241-7646 <br /> O It <br /> Site Contact; Dennis Doola <br /> RegiomUstrict%rea: Western Phone: 209 649-7176 Fax: 209 835-5974 <br /> Facility Address: Station 25705 W.Patterson Pass Rd. <br /> City: YM State: Ca. Zip: 95377 County: San 7oaggjq <br /> Locution Number: <br /> incident No.: Charge Code/SAPIBxpenselAFE 10011719 <br /> Send invoiceto Name: Domin o Nunez Address: 25705 W.Patterson Pass Rd. <br /> City: T _ State: Ca. Zip: 95377 Telephone; 209 834-8789 <br /> Material Description: Frac Liquid ❑ Yes ® Na <br /> debris and soil with crude oil <br /> Process generating this residual:(Be specific) clean up from relief valve failure <br /> Accumulation Date: 1015108 Sampling Date(if applicable) <br /> Type of container: Drums—How many � Type: <br /> Drum ID Numbers: <br /> Bias--How many 2 Siiza: 20yrd— Volume in Bin <br /> Sire: volume in Bin <br /> Bin Supplied by: Ba <br /> Bulk pilo Size (cubic yards) <br /> Other <br /> Any special requirements for drum pickup? (Rusty,missing parts, leakers,etc.) N/A <br /> Comments/Local Vendor Suggestion: <br /> N/A <br /> Form tilled out by: Dennis 22 MI Date: <br /> Phone: 209 649-7176 Fac: <br /> E-Mail Address: Company: <br /> NOTE: IF VERIFICATION FORM IS NOT RECEIVED BY SnE CONPACT WITHIN FIVE(5)DAYS, <br /> NOT FY RESIDUAL DISPOSAL COORDINATOR BY PHONE. =9= <br />