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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 Co., <br /> 140 Chevron Way, Richmond, CA 94802 '� � -7 <br /> Contact: Grace Chen 510-242-5918 or Michael Moir 510-242-1634 <br /> Chevron PM - Phone <br /> rc LLv1 <br /> Company, Department <br /> epartment ii EMC Bus. Unit, if a„p licable Charge Code <br /> C kv cvy fnA M 6JL PL 0 D <br /> Address /l -' PL <br /> —C�0 0.2Coof ?X n er C o <br /> Contract PM E-mail Phone <br /> Company, Address <br /> 5 milpling La tion (Address. ii ,{ Facility Number <br /> t �1W a � <br /> { } ervice Station ( } Fuel Termin I (} Marine Terminal Xpipeline ( } Refinery <br /> Other <br /> Chevron Texaco ( } Gulf ( } BP [ } Cumberland Farms <br /> Other <br /> Type of Analysis Desired <br /> { } Identify Product [ }Compare Spill with Potential Sources (Send Source Samples) <br /> ( }Compare am le .�+ith Previous Anal ses. Log Numbers and/or Dates: <br /> ❑they Lxpe � : f 0 bre KF&I MCall 510-242-5918 or 510-242-1634 for A roval <br /> Reason for Request(Clearly State Problem, Site History, Draw or Enclose a Map, Indicate Whether Leak or Spill) <br /> -c A� �.� �1 eco� -�rh e r C b+n•' ��>� <br /> Normal turn-around time is 4 weeks, Call 510-242-1634 to negotiate alternate arrangements. <br /> Number of Sample Name/Description Date Sampled <br /> Containers Sampled By <br /> Per <br /> Sample <br /> V�F 5 M ( co U AiD ccs A re 1Z <br /> Transporter Date Received Initials <br /> Laboratory Date Received Initials <br /> Chevron Energy Research &Technology 2,3 p, /G <br /> It is the shipper's responsibility to ensure Federal DCT regulations and UN performance standa ds 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 />