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CHAIN OF CUSTODY FORM Fq 2 Environmental Manaaement Comnanv is 145 S. State Colleae Boulevard ■ Brea. CA 92822-2292 COC 1 of <br />Chevron Site Global ID: <br />Chevron Consultant: Wayne Perry. Inc <br />ANALYSES <br />REQUIRED <br />-7n oc� <br />Address: 8281 Commonwealth Ave. <br />Special Instructions <br />Chevron Site Number: <br />/Ogs TTe+a TY pAQx,,.Ry ST.cIc7i ,� <br />Buena Park CA 90621 <br />10 <br />10 <br />Consultant Contact: S c-Ar22'�V <br />Chevron PM: ':7- <br />Consultant Phone No. 714-826-0352 <br />Chevron PM Phone No.: <br />Consultant Project No. <br />Sampling Company: Wayne Perry, Inc. <br />Sampled By (Print): /KAP-PsFAc <br />Sampler Signature: <br />x <br />O <br />W <br />Test America <br />Lancaster <br />Other Lab <br />Temp. Blank Check <br />■ Retail and Terminal Business Unit (RTBU) Job <br />� <br />o <br />Charge Code: NWRTB <br />■>Contact: <br />Laborat s <br />m <br />b <br />Time Temp. <br />❑ <br />1FF <br />2 <br />aO <br />(WBS ELEMENTS: SITEAssMT: AlUSITE MONT.:OMUREMo. <br />Laancaster, <br />PA <br />µNo c <br />wIMPL.:R5L/OP. <br />MAINT. &MON.: MIL) <br />Phab <br />Contact: Teresa <br />'yy' <br />Job ILL■ <br />❑ <br />Cu hamS <br />Phone <br />.-1- <br />X97ConstructioNRetail <br />y $(-o <br />❑ (717) 656- <br />= <br />p <br />\ <br />— <br />THIS IS A LEGAL DOCUMENT. ALL FIELDS MUST BE FILLED OUT <br />X <br />m <br />CORRECTLYAND COMPLETELY. <br />m <br />m <br />c <br />— <br />SAMPLE IDN <br />o <br />m <br />— <br />Sample <br />Time <br />Container <br />Type <br />Containers <br />Preservation <br />W <br />aToP <br />W <br />co <br />w <br />r <br />Point Name <br />Matrix <br />Depth <br />Date <br />mmdd <br />Notes/CommentsFleld <br />_ <br />2- <br />X <br />o rJ <br />y <br />v <br />00 <br />s <br />Relinquished ByCom y Date (fim Relinquished To Company <br />Turnaround TilTi <br />Dateme: �_ <br />24 Hours Standard ❑ <br />48 hours ❑ Other ❑ <br />el quis ed By Company Dat ime: Relinquished To Company <br />Sample Integrity: (Check by lab on arrival) <br />Relinquished By Company Date/Time: Relinquished ToG P ny ,, <br />Date/Time: <br />Intact: On Ice: Temp: <br />COC doc, 11/02/09 <br />