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Request for Environmental Analysis <br /> and Chain of Custody <br /> To:Environmental Analysis Lab, Roan 51-1151, Date <br /> ChevronTexaco Energy Technology Co., <br /> 100 Chevron Way,Richmond,CA 94802 I -71,95 <br /> Contact=Grace Chen 510-242-5918 or <br /> Michael Moir 510-242-16U <br /> GhevnariTexaoo PM <br /> pony, t it EMC At <br /> Unit, if applicable C Code <br /> Address &001 Rfli'n?er Cy n P(W) .5A I k7 C <br /> ContrW PM <br /> Dem ► e-A E a'i�, P % <br /> Company,Add <br /> -qTW WA-t AVe-i <br /> Samplm� (Address) p ! Fali�y Number <br /> fe K 7coOSS <br /> ( Service Station ()Fuel Terminal { ) Marine Terminal Pipeline () efinery <br /> Other <br /> Chevron ( )Texaco ()Gulf {) BP ()Cumberland Farms <br /> Other <br /> Type of Analysis Desired <br /> { )Identity Product ( )Compare Spill with Potential Sources(Send Source Samples) <br /> {)Comps SaRipir with Previous Analyses. Log Numbers and/or Dates: <br /> Other e f ri Call 514-242-59'18 or 510-242-1634 for Approval) <br /> Reason for Request(CWarly Stere Problem, Site History, Draw or Enclose a Map, Ind' Whether Leak or Spill) <br /> G�cou+�T f P-�t/�2 ,�fre4g5 4�ecT� <br /> Iowe vt.< ai)o ie ,r STS f.ul.Aicr- W �)v i j (Cyr or 5 a� <br /> C?-i,t>e ©/�� fur e'e FucL r' 7" <br /> WILL wee) To- j 2 t4;.a TTI SA k) J64u l� V'�}LL e <br /> OIL. re-ire t�ef�-�ic�v� j��►�s ��� �oca.�c � ice;�� fL- IF /DC�t�o� <br /> Normal turn-around time is 4 weeks. Call 510-242-1634 to negotiatee altemate arra %. <br /> Number of Sample NameVescription Date Sampled <br /> Containers Sampled By <br /> Per ` tt <br /> Sample I [7 Jos <br /> l `--` <br /> (�} -35 <br /> �. � 6A <br /> /,5':€0 <br /> Transporter Date Received initials <br /> Crory Date Received lnitia <br /> ChevronTexaco Energy Research&Technology // Fler <br /> it is the shippers responsibility to ensure Federal DOT regulations and UN peribm ante staWM8 are complied <br /> with.Consultation with a ChevronTexaco Regional Transport Specialist is Mandatory prior to air shipment_ <br /> Contact your ChevronTexaco Representative or call the Harmat Help Line{925484241659)for assistance.When in <br /> doubt,assume the sample is damnable 6/07/04 <br />