Laserfiche WebLink
1 <br />' WASTE PICK IIP REQUEST <br /> A2M AND EUE LiNg <br /> p <br />' To: Sharon Blanton y <br /> Waste Disposal Coordinator Anaheim, <br /> p Anaheim, CAA 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 />' Do you have a special Plck,-- es <br /> If yes, specify Date: 1Z rTime: <br /> t• Yes No <br /> Time: • eo A M <br />' Is the site open? Yes No <br /> If no, Is it locked? Yes __2L_ No <br /> Is this an operating service station? Yes No <br /> If no, what is currently on site? 5 V'-J� <br /> Is the waste accessible? Yes L No <br /> For bulk shipments , who will supply loader? <br />' Consultant Contractor Transporter <br />' C <br /> Company Name: a_UC9,0 <br /> Address: M 5D m - Q <br /> City: State: CA- <br /> Contact: -rLTivZip: 7 <br /> Phone: r& - -M-ZI/y <br /> Fax: 94.- 3 0 <br /> s <br /> District/Environmental Engineer: � KN <br /> I District: EE.RzA-y Phone: CS1Q) G-iS-Gle,� Fax: o `t _4t-1Z <br /> Ic <br /> Facility Address: <br /> pi4� <br /> City: G..,oD I I State: � Zip;County: 'A' 3OAQut.,1 <br /> WIC Number: o<• CT/DT: <br /> v.�yrno9r2ar9a <br /> I <br />