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Request for Environmental Analysis <br /> and Chain of Custody <br /> To: Environmental Analysis Lab, Room 51-1151, Dat <br /> Chevron Energy Technology Co., '30�' <br /> 188 Chevron Way,Richmond,CA 94802 i <br /> Contact:Grace Chen 518-242-5918 or Michael Moir 510-242-1634 <br /> Chevron PM Oj <br /> P ne <br /> I C- _C� 0(A VA S 2--5)W <br /> Company, Department: , C EMG Bus. Unit, if applicable Charge Code <br /> M L 00019 <br /> Address C r <br /> C ntra t PM Em it <br /> Company,Address 0 <br /> NVL0.4342at-tv, S� 6.75 �kl�iid C .1 1)Z <br /> Sampling Location{Address}_ ,Farc, ilily� Number ca4fZ-.1-4 [�,Utf- D&o L;i-fe LL f 17 o J j7r-4, V A <br /> { } Service Statio { } Fuel Te inal () Marine Termin6l KpipelKe ( } R finery <br /> ether <br /> Chevronexaco { }Gulf { ) BP { }Cumberland Farms <br /> ther <br /> Type of Analysis Desired <br /> (} Identify Product ()Compare Spill with Potential Sources(Send Source Samples) <br /> (} Compare Samples with Previous Analyses. Log Numbers and/or Dates: <br /> ther G• (Call 510-242-5918 or 510-242-1634 for Approval) <br /> Reason for Request(CleArlyState Problem, Site History, Draw or Enclose a Map, Indicate Whether Leak or Spill) <br /> G )i4 � f�CC�C'G /I) ., fir' 6s1k l�e�' 1�[Z -'L9 oil <br /> -hie- ri <br /> �u le-1 <br /> ��-• <br /> ormal turn-around time is 4 weeks. all 510-242-1634 to negotiate alternate arrangements. <br /> Number of Sample Name/Description Date Sampled <br /> Containers Sampled By <br /> Per <br /> Sample �1 l C ��.� �� jCl❑cor-k <br /> 3/2Cf C <br /> C .- J 2.3 [�r�o CCL' <br /> 15 2-0 <br /> Transporter_ Date Received Initials <br /> LIP e <br /> Laboratory Date Received Initials <br /> Chevron Energy Research&Technology <br /> It is the shipper's responsibility to ensure Federal DOT regulations and UN performance stands s are complied <br /> with.Consultation with a Chevron Regional Transport Specialist is Mandatory prior to air shipment. Contact your <br /> Chevron Representative or call the Hazmat Help Line(925-842-8659)for assistance.When in doubt, assume the <br /> sample is flammable 07/10/06 <br />