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Request for Environmontal Analysis <br /> and Chain of Custocly <br /> To: environmental Analysts Lab, Room 51-1151, Date <br /> ChevronTexnco energy Research&Technology Co., <br /> 100 Chevron Way, Richmond,CA 94602 <br /> Contact: Grace Chen 510-242-S918 or I I <br /> ChevronTexaco PM ,�o� �G`� Phone <br /> x- <br /> Company,Department EMC Bus. Unit, lr applicable Charge Code6 <br /> loo- of +q <br /> Address �J <br /> See et 4",,-t � <br /> Contract PM E-mail Phone <br /> K � mnrt �l,or�G re, e�c.of.c, 916 tv 040c) x z <br /> Corn)any,Addres <br /> ?lot-i K,� _ is CAr a%70 <br /> Sampling Location(A dress) Facility Number <br /> 1 1"�'- c 4 <br /> ( )Service Station N Fuer Terminal ( Marine rminel ()Pipeline ( ) Refinery <br /> ll.,d OwK ty kT&z <br /> Qq Chevron ()Texaco )Gulf ()BP ()Cumberland Forms <br /> Other <br /> Type of Analysis Desired <br /> Identify Product ( )Compare Spill with Potential Sources(Send Source Samples) <br /> Compare Samples wilts Previous Analyses. Log Numbers and/or Dates: <br /> Other Call for royal <br /> Reason for��Request(Clearly State Problem, Site History, Draw ar Enclose a Map, Indicate Whether Leak or Spill) <br /> xf i-1 y I /L u�//��� JS +�-, �i�i�i r /7C,or?sn&ra..5 er I r <br /> +- � !K Qr d{•,,,��. . GosS�CI irtRl •�brplpl o ►su+'h�5 1� r G-�-1�tcf< <br /> Normal tum-around time is 4 weeks. Call 510-242-4993 to negotiate alternate arrangements. <br /> Number of Sample NarnelDescription Date Sampled <br /> Containers Sampled By <br /> Per <br /> r� <br /> Sample 6 , C- .0 , )n 2_ 4P 1104 s C4.tl� <br /> A 4 <br /> 1 s g - t r 6�5 ' 6a';\) ae� 'A" bill/a4 s- colt, <br /> I S 6 _3 -7:� ' �o;l� � t JRA r� 6,a11o4 's.C011e. <br /> $ SS 4/ZI fc� S- Cal <br /> $ SF, - 1 - GAJ l 4� 1 � 'C, .! `" f b(11164 S. Cpl(� <br /> $ S 8- - G w ( Ciy,►.�+ u� I f. � / bpi�ay s • C.,.11� <br /> Transport r !;NR teed Inde <br /> L <br /> Laboratory D te-R calved In' 'els <br /> ChevronTexaco Energy Research &Technology 1// 4 <br /> It is the shipper's responsibility to ensure Pederal DOT regulations and UN p rformancQ state aids are complied <br /> with.Consultatlon with a ChevronTexaco Reglonal Transport Specialist Is Mandatory prior to air shipment. <br /> Contact your ChevronTexaco Representative or call the.Hazmat Help Line(925-642-8659)for assistance.When In <br /> doubt,assume the sample Is flammable 1019102 <br />