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__� 9 2-, ) ( <br /> RESIDUAL INFORMATION PICK UP REQUEST <br /> SHELL TERMINALS AND PIPELINE <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 /> Sherell Heidi CA,HI,OR,WA 7131241-5036 713/241-7646 <br /> Nancy Groves AL,LA,CO, IL,IN,KS,KY,M1,MS,MT,OH, 713/2410858 713/241-2997 <br /> TX <br /> SITE INFORMATION <br /> Site Contact: Jose Zavala Jr. <br /> Region/District/Area: western Phone: 209-244-3601 Fax: 209-835-5974 <br /> Facility Address: 25705 Patterson Pass Rd. <br /> City: Tracy State: Ca Zip: 95377 County: San Joagiun <br /> Location Number: <br /> Incident No.: Charge Code/SAP/Expense/AFE <br /> Send invoice to Name: Domingo Nunez Address: 25705 Patterson Pass Rd <br /> City: Tracy _ State: Ca Zip: 95377 Telephone: 209-835-8789 <br /> Material Description: Free Liquid ❑ Yes x No Project Remediation❑ Spill❑ <br /> Oily debris<crudes absorbent pads and Mastic <br /> Process generating this residual: (Be specific-for example: blasting of floor of crude oil tank 306) <br /> Tracy pum pads clean u <br /> Accumulation Date: 7-27-09 Sampling Date(if applicable) <br /> Type of container: Drums—How many 3 Type: 55 gallon open head ring lid <br /> Drum ID Numbers: D-1 , D-2 D-3 <br /> Bins—How many Size: Volume in Bin <br /> Size: Volume in Bin <br /> Bin Supplied by: Bin Number(s) <br /> Bulk pile Size (cubic yards) <br /> Other <br /> Any special requirements for drum pick-up? (Rusty,missing parts, leakers,etc.) no <br /> Comments/Local Vendor Suggestion: <br /> Foran filled out by: Jose Zavala Jr Date: 7-27-09 <br /> Phone: 209-244-3601 Fax: 209-835-5974 <br /> E-Mail Address: Jose.Zavala-Jr(ashell.com _ Company: Shell pipeline co <br /> NOTE: IF VERIFICATION FORM IS NOT RECEIVED BY SITE CONTACT WITHIN FIVE(5)DAYS, <br /> NOTIFY RESIDUAL DISPOSAL COORDINATOR BY PHONE. 11/10/04 <br />