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Request for Environmental Analysis <br /> and Chain of Custody <br /> To: Environmental Analysis Lab, Room 51-1151, Date <br /> ChevronTexaco Energy Technology Co., <br /> 100 Chevron Way, Richmond, CA 94802 <br /> Contact: Grace Chen 510-242-5918 or Michael Moir 510-242-1634 <br /> ChevronTexaco PM Phone <br /> Company, Department EMC Bus. Unit, if applicable Charge Code <br /> v it 1�tt nn� �'o. 5 erfuvtc� E N WCPL -000a <br /> Address <br /> UP Q1 1 1 t' CLIWO o won, CA <br /> Contract PM E-mail Phone <br /> bws J <br /> Company, Address <br /> SAI C VE, Sut�el }Uwileitqr� r. <br /> Sampling Location (Address) Facility Number <br /> MIN ro CA _ <br /> ( }�S�i e State} Fuel Tbrminal Marine Terminal XPipeline [ } Refinery <br /> Other <br /> N Chevron Texaco ( ] Gulf [ } BP 4 } Cumberland Farms <br /> Other __ <br /> Type of Analysis Desired <br /> } Identify Product '( )Compare Spill with Potential Sources(Send Source Samples) <br /> { } Compare Sarniples with Previous Analyses. Loa Numbers and/or Dates: <br /> Other Tuiti, 6_0. ih_ __� _ _ (Call 510-242-5918 or 510242-1634 far F�� roval <br /> Reason `or Request{Clearly State Problem, Site History, Draw or Enclose a Map, Indicate Whether Leak or Spill} <br /> 0-(-�Sl'+e SQ W p}41 <br /> Cult organ iGs <br /> i Normal turn-around time is 4 weeks, Call 5,10-242-1634 to negotiate alternate arrangements. <br /> Number of Sample Name/Description Date Sampled <br /> Co;,*ainers Sampled By <br /> I Per <br /> Sample <br /> i <br /> Safi 1'e- 4/130/CIT L. YlCbff <br /> Ip <br /> I <br /> !I <br /> i <br /> 1 Transporter Date Received Initials <br /> Laboratory Da!e_ celyyed �lnitials I �ol <br /> ChevronTexaco Energy Research Technology �_ f /p L'L4 <br /> It is the shipper's responsibility to ensure Federal DOT regulations and UN performance standards are complied <br /> Witt]. 'Consultation With a ChevronTexaco Regional Transport Specialist is Mandatory prior to air shipment. <br /> Contact your ChevronTexaco Representative or call the .4azmat Help Line (925-842-8659) for assistance. When in <br /> j doubt, assume the sample is flammable 6107104 <br /> Guidelines for shipping samples to ETC for `nvironrnental Analysis <br />