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RESIDUAL INFORMATION PICK UP REQUEST <br /> E UILON TERMINALS AND PIPELINE <br /> Equilon Pipeline Company, P. 0.Box 2648 Houston,TX 77252-2648 Date: 4/30/2009 <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 /> RDC AREA PHONE FAX <br /> Tena Henry DE,IL,KY,LA,MS,NM,OK,TX,UT 713/241-0236 71312414119 <br /> Kyle Hunt CO, IL,IN,KS, MI,MO,MT, NE,OH,OK,WY 7131241-4395 711/241-7159 <br /> Lisa Reaves AK,AZ,CA, CO,HI,KS,NV,Olt,WA 713/241-8894 713/241-7646 <br /> SITE INFORMATION <br /> Site Contact: Dennis Dool <br /> Region/District/Area: Western Phone: 209 649-7176 Fax: 209 835-5974 <br /> Facility Address: T±aq 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 10011271 <br /> Send invoice to Name: Domingo Nunez Address: 25705 W.Patterson Pass Rd. <br /> City: Tra State: Ca. Zip: 95377 Telephone: 209 834-8789 <br /> Material Description: Free Liquid ❑ Yes Z No <br /> oily debris crude <br /> Process generating this residual: (Be specific) clean up from heat exchanger rebuild <br /> Accumulation Date: 4125109 Sampling Date(if applicable) <br /> Type of container: Drums—How many Y7 Type: 55 gal.open head,ring lid <br /> Drum ID Numbers: D 1,D2 D3 D4 DS D6 D7 <br /> Bins—How many Size: Volume in Bin <br /> Size: Volume in Bin <br /> Bin Supplied by: ^Bayview <br /> Bulk pile Size (cubic yards) <br /> Other <br /> Any special requirements for drum pick-up? (Rusty,missing parts,leakers,etc.) N/A <br /> Comments/Loeal 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 RECEIVED BY SITE CONTACT WITHIN FIVE(5)DAYS, <br /> NOTIFYRESIDUAL DISPOSAL COORDINATOR BY PHONE. 0=9100 <br />