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Request for Environmental Analysis <br /> and Chain of Custody <br /> To, Environmental Analysis Late, Doors 51-1151, Date <br /> ChevronTexaco Energy Research &Technology Co., <br /> 100 Chevron Way, Richmond, CA 94802 f ,� <br /> Contact, Grace Chen 510-242-5918 or Michael Moir 518-242-1634 `• ( � ' <br /> ChevronTexaco PM Phone <br /> Scott Mansholt 925 842-1804 <br /> Company, Department EMC Business Unit, if applicable Charge Code <br /> Chevron Environmental Management Company Su erfundlPro ert Mana mnt 1 &►.v t 'P_- 6< CC- I <br /> Address <br /> 6001 Bollinger Canyon Road, K2050, P.O. Box 6012, San Ramon, CA 94583 <br /> Contract PM 4 E-mail C Phone <br /> iColn J <br /> cum, h ►� ,_' <br /> Company, Address <br /> 6001 Bollinger Canyon Road, K2068, P.O. Box 5012, San Ramon, CA 94583 <br /> Sampling Location (Address) Facility Number <br /> ❑ Service Station ❑ Fuel Terminal ❑ Marine Terminal 0 Pi eiine CIRefinery, ❑ Other <br /> i] Chevron ❑ Gulf ❑ BP ❑ Cum berfand Farms 0 Other: Texaco or other <br /> Type of Analysis Desired <br /> l] Identify Product ❑ Compare Spill with Potential Sources (Send Source Samples) <br /> ❑ Compare Samples with Previous Analyses. Log Numbers and/or Dates: <br /> ❑ Other Call 510-242-4993 for Approval) <br /> Reason for Request tClearly State Problem, Site History, Draw or Enclose a Map, IndicateV i -t>h.%r gak or Spill) <br /> 11 ''Wfa I V1 Ve-M`h{„�L `�.•JA <br /> �•rw lM 1'�>t �-�. ��{LCTC� �Cl.]�c (��GeI�1�ICIIQ�T�'iPn I.'L�a��`= eoX-�-f-iC•"'7#1- C�i�v. kGXW� msiCcT�nCw� Slvtta <br /> �Please fingerprint samples and identify potential sources. 5<3,� �� � l <br /> stl-u, X13-Z� 5A <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 /> As <br /> ,5 �. � f, � ti'a� <br /> I -Zy I0,5 AS �E <br /> rV f/,---,i V!9f A <br /> Transporter Dae Received Initials <br /> 4z <br /> Laboratory Da e R ceived initials LX,) <br /> ChevronTexaco Energy Research & Technology o <br /> It is the shipper's responsibility to ensure Federal DOT regulations and UN performance standards are complied <br /> with. Consultation with a ChevronTexaco Regional Transport Specialist is Mandatory prior to air shipment. <br /> Contact your ChevronTexaco Representative or call the Hazmat Help Line (925-842-8659)for assistance. When <br /> in doubt, assume the sample is flammable <br />