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CHEVRON PRODUCTS COMPANY <br />Request for Drill Cutting/SoilfWater Removal <br />Tii IWM, lnL {Atte .T6NAo,3t_E) <br />Chevron Reference Information <br />950 Ames Ave, Milpitas, CA 95035 Contact �,CA�.,,, <br />Tel (408) 942-8955 <br />Phone 945:�_ 2, - 9�sC <br />Fax (408) 942-1499 <br />Chevron Release No -Q 2-3Z Ni <br />Frcirn T1 1' y L+,5 <br />pt a me <br />' Sample Information <br />lAnalyttcal <br />lab <br />5 Q <br />Data submitted <br />Company <br />Process generating <br />drill cuttings/soil W(fl) <br />Telephone/Fax <br />Site Information <br />Station No - 5 S Cross street 5,,A PJef Sc <br />Addretis ;0) Current site use <br />City LCA i <br />f <br />� <br />SPECIAL INSTRUCTIONS r J <br />� le Le <br />For tide aLLess U �,., (;� �,. <br />�. ?1 �.�d c� <br />1 <br />s' 5- r 5 c� Gam'.., % �-, �U <br />Key req fired Yes No <br />Site contact Phone No <br />.Nw 0 <br />Calculation <br />of Drill Cutting Volume <br />Boring Diameter <br />Volume Conversion Factor <br />0 016 <br />8• <br />10• <br />0 024 <br />1T <br />0 035 <br />Boring Number of <br />Boring Depth Volume Conversion Volume <br />diameter Bonn 5 <br />_ _ Factor -- - _ - - ^(cubic yards)- <br />_ _ <br />Z , �5 <br />' X <br />X — - <br />1 <br />X X = /a1 <br />- - �4Ln �r►7� _ � deS Qk3T�HZe•t� v� .3Z3C.K:)0C C:Ja—= 5Z _ Wa= ej �Kt7l <br />(���� <br />If Drums now man) ZQ ! <br />Other kinds of waste voiume <br />OLEASE INSTRUCT THE LAB TO FAX A COPY OF THE ANALYTICAL REPORT AND COC TO IWM, <br />INC., <br />AND SUBMIT A COPY OF THE COC WITH THIS REPORT. <br />TOTAL P 02 <br />