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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-MAI to the 1 <br /> Residual Disposal Coordinator for characterization and transportation of material. <br /> RDC AREA PHONE FAX <br /> Sherell Heidt CA,HI,OR,WA 7131241-5036 7131241-7646 <br /> Nancy Groves AL,LA,CO,IL,IN,KS,KY,MI,MS,MT,OH, 713/241-0858 7131241-2997 <br /> _Ray WaIding TX <br /> SITE INFORMATION <br /> Site Contact: Jose Zavala Jr <br /> Region/District/Area: Western Phone: 209-835-3723 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 Code/SAP/Expense/AFE <br /> Send invoice to Name: Domingo Nunez Address 25705 Patterson Pass Rd, <br /> City: Tracy State: Ca Zip: 95377 Telephone: 209-834-8789 <br /> Material Description: Free Liquid ❑ Yes ❑ No Project x Remediation ❑ Spill❑ <br /> Oily absorbent pads and plastic <crude> <br /> Process generating this residual: (Be specific-for example: blasting of floor of crude oil tank 306) <br /> Pump pad clean up <br /> Accumulation Date: 1-13-10 Sampling Date(if applicable) <br /> Type of container: Drums—How l Type: 55 gallon open head ring lid <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: Numbers) <br /> Bulk pile Size (cubic yards) <br /> Othe <br /> r <br /> Any special requirements for drum pickup? (Rusty,missing parts, leakers, N/A <br /> etc.) <br /> N/A <br /> Comments/Local Vendor <br /> Suggestion: <br /> N/A <br /> Form filled out by: Jose Zavala Jr Date: 1-13-10 <br /> Phone: 209-835-3723 Fax: 209-835-5974 <br />