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11 179 95 11 20 $510 S42 9252 CHE1ROti PRODtCTS --- TOLCHSTLAE DEI Z oo2 oo5 <br /> 1112204 09.26 6 From aLrAbe&&Hetvey Ta Kcn Kar' Page 1 of S <br /> �-Q Request for Environmental Analysis <br /> + and Chain of Custod <br /> ro7EW=1ro—nmental Analysis Lab,Room 50-1128, Date <br /> Chevron Research 8 Technology Co , <br /> 900 Chevron Way, Richmond, CA 94802 II <br /> Contact Liz Harvey510-242.4993 or.ferry Kimberlin 510-242-21fi1 <br /> Requestor(Chevron) Phone 13 Li <br /> Cprnpany, Department, Strategic Business Unit Charge Code <br /> ROOIIC-US Co/m RSG 4b3� f"ODIt 62&4 U00i <br /> Address <br /> c--to N r <br /> Sampler Phone <br /> JtF� r1�N�tac � 53$- 8+$ <br /> Company, Address n <br /> IGVC,ZSiG i1�rE4 ,1 07. � � SA117k Y-05A C <br /> Sampling Location (Address) <br /> qiS 'TRAev bt--Jb Tkoq CA SF-RV S-rry <br /> Service Station D Fuel Terminal r_; Marine Terminal DlPipefine ©Refinery 00ther <br /> Chevron OGuff 0 BP ❑Cumberland Farms ❑Other <br /> Type of Analysis Desired <br /> gidentlfy Product 0 Compare Spill with Potential Sources (Send Source Samples) <br /> ❑Compare Samplas with Previous Analyses Log Numbers and/or Dates <br /> Other ?CTEV—T1 ora VRr Y Atit awrc Rptw« Stu-vir1 nz4- 4 4�4Ti,* Aar Cali 510-242-4993 for Approval) <br /> Reason For Request(Clearly State Problem Site History Draw or Enclose a Map, Indicate Whether teak or Spill) <br /> r-ovut`C aF ONt•1 r+/eL -r+tnllt P11 <br /> 1�1SC6rJ�RC11 pVR1NG Rou-rlrOE -TAnlY-- Q-E7nOVAL. TFPjicS F'C '^^pvtiA wiipL OP-1 1"VaL <br /> S�nJG���+„Jfrz�gU �iBt�G+�RSS �"fti4`( +.la=RC tv PtrFICE SIt1G.0 5Y+4�TICaJ "�I�S"L' �11iL—f 1i� <br /> IQ-:v'l. Cz -TIPnl wk-% Att,lnyS 01S(11-Q'&z13 GflSt}rv,,UC �LLJGrrmc , rntel--JroAC IR-L-6 �1cSct <br /> \),i--11C2 pp'O(rc]2i% WAS Op'lop- -ro kwF1c-Lru I �41T---LL. <br /> 4-CR-Ilan) 1S PdSs1 �� vPGRRt?rr<a.1T <br /> Normal turn-around time is 4 weeks Call 510-242-4993 to negotiate alternate arrangements <br /> Sample Number of Sample Name/Description Date Sampled <br /> Number Containers Sampled BY <br /> Per Sample <br /> � 4 <br /> -7 � <br /> � I � <br /> Trarisp rt / Pate <br /> Received �ntials <br /> Laboratory ec Ived t , als <br /> Chevron Research &Tec nology (f Q <br /> it Is the shipper's responsibility to ensure Federal DoT regulations and IV performances ndards are compiled i <br /> with Consultation with a Chevron Regional Transport Specialist is Mandatory prior to air shipment Contact <br /> your Chevron Representative or call the Hazmat Help Line (415.894-3481)for assistance When In doubt, l <br /> assume the sample is flammable 9127/94 <br />