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CHEVRON PRODUCTS COMPANY <br />Request for Drill Cutting/SoillWater Removal <br />Tu. IWM, Inc. (Atte .Tjig 6Nr,()gLC- ) <br />950 Ames Ave , Milpitas, CA 95035 <br />Tel (408) 942-8955 <br />• <br />Fax (408) 942-1499 <br />From TI., �� f ,.,5 <br />Name <br />J Lc' O jZ r«fG <br />Company <br />�i(r- E/-vYc.� / 9 /G - �T r-Q'I30 <br />Telephone/Fax <br />Station No q -j7-7!5- <br />Address <br />j SAddress U 1 LA -4 Ke - 11 P,C-111 <br />Cityri <br />Chevron Reference Information <br />lContact <br />'PhoneIZ —gGSs <br />Chevron Release No 9Z37- y <br />Sample Information <br />lAnalytical lab <br />Date submitted Z <br />Process generating, / <br />drill cuttings/soil <br />Site Information <br />Cross street �� P/e,, SG y4 <br />Current site use <br />SPECIAL INSTRUCTIDAI$ f <br />Fur mte ac.LeSs c„ G K �1 S :c Kl2 <br />% <br />Key req fired Yes No Site contact Phone No <br />Calculation of Drill Cutting Volume <br />Boring Diameter Volume Conversion Factor <br />8" 0 016 <br />10" 0 024 <br />12` 0 035 <br />Boring Number of <br />Diameter Bonn s <br />t -Z <br />l <br />Boring Depth Volume Conversion Volume <br />_____-------��— -- _ Factor _ _ - -(cubic yards) <br />x x <br />X X = <br />�S.-C]Y��_✓�'7tt"IC,�V-� �i:f�IC71lcv .^.`.i"- �..`� Ja' _` �j�S�, <br />If drums now man) 2-0 <br />-�-- - – -- -- Other kinds of waste volumeAiv ^) <br />,PLEASE 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 />