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RESIDUAL INFORMATION PICK UP REQU_ES r� <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 Heidt CA,HI,OF,WA 7131241-5036 7131241-7646 <br /> Nancy Groves AL,LA,CO,IL, IN,KS,KY,MI,MS,MT,OH, 7131241-0858 7131241-2997 <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 Joaquin <br /> Location Number: <br /> Incident No.: Charge Code1SAP/Expense/AFE 10011271 <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 gravel with crude <br /> Process generating this residual: (Be specific-for example: blasting of floor of crude oil tank 306) <br /> Cleaning um ads <br /> Accumulation Date: 8-26-09 Sampling Date(if applicable) <br /> Type of container: Drums—How I Type: 55 Gallon,open head drum <br /> many <br /> Drum ID Numbers: D-1 <br /> Bins—How many Size: Volume in Bin <br /> Size: Volume in Bin <br /> Bin Supplied Bin <br /> by: Numbe s <br /> Bulk pile Size (cubic yards) <br /> Othe <br /> r <br /> Any special requirements for drum pick-up? (Rusty, missing parts, leakers, na <br /> etc.) <br /> Comments/Local Vendor <br /> Suggestion: <br /> Form filled out by: Jose Zavala Jr Date: 8-27-09 <br /> Phone: 209-244-3601 Fax: 209-835-5974 <br />