Laserfiche WebLink
Request for Environmental Analysis and Chain of Custody <br /> To: Environmental Analysis Lab, Room 51-1151, Date <br /> Chevron Energy Technology Co., 100 Chevron Way, Richmond, CA 94802 <br /> Contact: Grace Chen 510-242-5918; Michael Moir 510-242-1634; Rachel Mohler 510-242-4939 3/,�/O <br /> Chevron PM: t Scott Mansholt(925) 543-2353 ❑ Lee Higgins (925) 543-2365 ❑Other: <br /> Company, Department EMC Bus. Unit, if applicable Chevron Phar e_Code NWCPL00003M20] <br /> Chevron Environmental Management Company SFSP � <br /> Address: 6111 Bollinger Canyon Road, San Ramon, CA 94583 <br /> Project M nager(s) E-mail Phone <br /> V�A4/ f /�1` ' may! 7 fA <br /> �LJ L�l � ���tit ���^��� r c���/�� �I iC/ 3 <br /> Company, Address:❑ SA1C, 3800 Watt Avenue, Suite 210, Sacramento, CA 95821SAIC, 1000 Broadway, Suite 675, Oakland, CA, 941507 <br /> ❑AM EC Geomatrix, 2101 Webster St., 120 Floor, Oakland, CA 94512 �ARCADIS, 2033 North Main St., Suite 340, Walnut Creek, CA 94596 <br /> Sampling Loc tion (e.g., Street Address, City, State) Site Name (e.g., AldenPark) <br /> J ` <br /> PIPELINE: ❑ Chevron (OW) Texaco (TAOC) Both (OVP &TAOC) ❑Other: <br /> Normal turn-around time is 4 weeks. Call 510-242-1534 to negotiate alternate arrangements. <br /> Sample Date &Time Number of Media Fuel ICP Other Notes <br /> Flame Sampled Containers (e.g.,soil Fingerprint Analysis <br /> or water <br /> Sa pled By(Print Clearly}� Relinq d (Date & i e) Initials <br /> Transp Print Clearly - Rec e & ime) Initials <br /> Labot' ry Received (D to &Time} Initials <br /> Chevron Ener Research &Technology6 0 <br /> It is the shipper's responsibility to ensure Federal COT regulations and UN performance standards are complied with.Consultation with a Chevron <br /> Regional Transport Specialist is Mandatory prior to air shipment. Contact your Chevron Representative or call the Hazmat Help Line(925-842-8659) <br /> for assistance. When in doubt, assume the sample is flammable. 02117/09 <br />