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Request for Environmental Analysis <br /> and Chain of Custody <br /> To: Environmental Analysis Lab, Room 51-1151, Date <br /> Chevron Energy Technology <br /> 100 Chevron Way, Richmond,, CA CA 94802 7 U <br /> Contact: Grace Chen 510-242-5918 or Michael Moir 510-242-1634 <br /> Chevron PM: M. Scott Mansholt Phone: 925 842-1804 <br /> Company, Department EMC Bus. Unit, if applicable Chevron Charge Code <br /> Chevron, Environmental Management Company SFSP NWCPL00020Al0 <br /> Address: 6001 Bollinger Canyon Road, K2066, San Ramon, CA 94583 <br /> SAIC PM/Contacts E-mail Phone <br /> Lee Higgins leehiggins@chevron.com (925) 842-4752 <br /> Mike Hurd MICHAEL.T.HURD@saic.com (510) 466-7161 <br /> Will Slowik William.p.Slowikw@saic.com (559) 638-7655 <br /> Company, Address <br /> (X)3800 Watt Avenue, Suite 210, Sacramento, CA 95821 <br /> 1000 Broadway, Suite 675, Oakland, CA, 94607 <br /> Sampling Location (Address) Site Name <br /> 35275 Welty Road, Vernalis,CA.,95385 US Can-Welty Road <br /> ( ) Service Station ( ) Fuel Terminal ( ) Marine Terminal (X) Pipeline ( ) Refinery <br /> Other <br /> (X) Chevron ( ) Texaco ( ) Gulf ( ) BP ( ) Cumberland Farms <br /> Other <br /> Type of Analysis Desired <br /> (X) Identify Product ( ) Compare Spill with Potential Sources (Send Source Samples) <br /> ( ) Compare Samples with Previous Analyses. Log Numbers and/or Dates: <br /> Other Call 510-242-5918 or 510-242-1634 for Approval) <br /> Reason for Request(Clearly State Problem, Site History, Draw or Enclose a Map, Indicate Whether Leak or Spill): <br /> Fingerprint sample to identify potential sources. <br /> Normal turn-around time is 4 weeks. Call 510-242-1634 to negotiate alternate arran ements. <br /> Number of Sample Name/Description Date Sampled <br /> Containers Sampled By <br /> Per <br /> Sample <br /> I 5 6a 3 fib. ' gllg/o8 56 <br /> MO's 13/OS 5. <br /> S <br /> Sv as - 4,91 g , -S/09 55 <br /> ag` 1 ;y og <br /> Transporter Date Received Initials <br /> Laboratory Date Received Initials <br /> Chevron Energy Research &Technology 97 u,/p <br /> It is the shipper's responsibility to ensure Federal DOT regulations and UN performance standards are complied <br /> with. Consultation with a Chevron Regional Transport Specialist is Mandatory prior to air shipment. Contact your <br /> Chevron Representative or call the Hazmat Help Line(925-842-8659)for assistance.When in doubt,assume the <br /> sample is flammable 07/10/06 <br /> Guidelines for shipping samples to ERTC for Environmental Analysis <br /> Sample containers and desired volumes: <br />