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Reques. .jr 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: Environmental Lab 510-242-5918 or Deyuan(Kitty) Kong 510-242-1654 <br /> Chevron PM: Michael Oliphant ❑Other: <br /> Company, Department EMC Bus. Unit, if applicable Chevron Charge Code (e.g., NWCPL00003M20) <br /> Chevron Environmental Management Company SFSP iV W t-A J V C PLQQ W ) - 0 ,)L <br /> Address: 6111 Bollinger Canyon Road, San Ramon, CA 94583 <br /> Project Manager(s) E-mail Phone __ <br /> VV, ►1 SlOw1k 55� -(�3g-7c-9Y <br /> gel, <br /> Cc . Set", Gehll� kzSe ,c co--, Sly - y6&- 7 18 <br /> Company, Address:❑SAIC, 3800 Watt Avenue, Suite 210, Sacramento, CA 95821 ) SAIC, 1000 Broadway, Suite 675, Oakland, CA, 94607 <br /> ❑AMEC Geomatrix, 2101 Webster St., 12`h Floor, Oakland, CA 94612 ARCADIS, 2033 North Main St., Suite 340, Walnut Creek, CA 94596 <br /> Sampling Location (e.g., Street Address, City, State) Site Name (e.g., Alden Park) <br /> Normal turn-around time is 4 weeks. Call 510-242-1654 to negotiate alternate arrangements. <br /> Sample Date&Time Number of Media Fuel Metals Other Notes <br /> Name Sampled Containers (e.g.,soil Fingerprint analysis Analysis <br /> or water) by ICP ® Fingerprint sample to identify <br /> any hydrocarbon that Smay be <br /> present. <br /> Y <br /> ampled By(Print Clearly) Relinquished (Date &Time) Initials <br /> Ce 11I�� <br /> _Z/121>1 /z I S (�o A�' <br /> Transporter(Print Clearly) Received (Date &Time) Initials <br /> E`?Z,Z S' r--- <br /> Laboratory Received (Date &Time) Initials <br /> Chevron Energy Technology Company <br /> It is the shipper's responsibility to ensure Federal DOT 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 06/17/09 <br />