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i <br /> WASTE PICK UP REQUEST <br /> RETAIL, DISTRIBUTION ,AND PIPE LINE <br /> To: Sharon Blanton P.O. Box 4848 <br />' Waste Disposal Coordinator Anaheim, CA 92803 <br /> Shell Oil Company Phone: 714-520-3312 <br /> Fax: 714-520-3570 <br />' This form must be filled out completely and all analyses <br /> attached. Mail or FAX to the Waste Disposal Coordinator for <br /> characterization and transportation of material . <br />' Doou have a <br /> y special pck u� .request. Yes No <br /> If yes , specify Date: i�9„ Time: 3 .cV & w► <br />' Is the site open? Yes No -X-- <br /> If no , is it locked? Yes >,:5' No <br />' Is this an operating service statio ? Yes No <br /> If no, what is currently on site? <br /> Is the waste accessible? Yes -Ll- No <br /> For bulk shipments , who will supply loader? <br />' Consultant Contractor Transporter <br />' CONSULTANT OR„.CONTRACTOR INFO_ ..R1IMION <br /> Company Name: _7-F-06_” WEAddress: o T— " <br /> City: State: C4%- Zip: 051-79 <br /> Contact: 10,22,-r nn.,k,c r...� _ phone: 1 c� -71-1- Z110 <br /> Fax: ( Itk2 -71 &--7910 <br /> SHELL INF9R=I0N <br /> District/Environmental Engineer: --J[-'>A-o.) Kta.4. <br />' District: Phone: o)e.7 -6I&Y Fax: <br />' SHELL FACILITY INFORNATION <br /> Facility Address: 42$0Lc.rge- <br />' <br /> city: o , State: C44- _Zip: _ounty• . a u,a <br /> W2 C Number: 2,-?Y-gqt(, - n 8 01. CT/DT: <br /> v�+a�wrlo�g+ <br />