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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 Research & Technology Co., <br /> 100 Chevron Way, Richmond, CA 94802 1 <br /> Contact: Grace Chen 510-242-5918 or Michael Moir 510-242-1634 `•�' I <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 Superfund/Property Mana mnt ►v c.. ?L- Ut; �' i <br /> Address <br /> 6001 Bollinger Canyon Road, K2050, P.Q. Box 6012, San Raman, CA 94583 <br /> —-:_ -S,7. 4 � <br /> Contract PM E-mail Phone <br /> Company, Address <br /> 6001 Bollinger Canyon Road, K2068, P.O. Box 6012, San Ramon, CA 94583 <br /> SamplinQ�ocation (Address) Facility Number <br /> ❑ Service Station ElFuel Terminal El Marine Terminal 0 Pipeline ❑ Refinery ❑ Other <br /> 0 Chevron ❑ Gulf ❑ BP ❑ Cumberland Farms 0 Other: Texaco or other <br /> Type of Analysis Desired <br /> D 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 (Clearly State Problem, Site History, Draw or Enclose a Map, Indicate Vtgth%ril.qak or Spill) <br /> rr'i � � �-�,^P, ��.,l �) , 1��. �•�c 1�.�w� �'ta t � �E��� � ���t Le'—""F c- C'�- �J�"� i�a '�r�"iL� ��-�� <br /> III sjws t VL Ve_rhC.it t;, C_A o L T� 4'Ca a. a 1 <br /> �` U f i0L'1 Iv. W Ini� S <br /> j vr+yyP++� U-Y—r ct'I�t��C l� s �� A IA6_ V <•it <br /> ql-Y :4 Y�5t1�T v C� cck !ti t I'� �i � << J <br /> 1 5�..r... �lc �� c� <br /> Please fingerprint samples and identify potential sources. 1&sQ <br /> 1 -7 -a -,,L)- 3 <br /> Normal turn-around time is 4 weeks. Call 510-242-4993 to ne otiate alternate arrangements. <br /> Sample Number of Sample Name/Description _ Date Sampled <br /> Number Containers ' ` V"' Sampled By <br /> Per Sample J° <br /> rw%, i 1 A <br /> j� 0 Js ,} <br /> \-? 1. 5 z/a, S t r t s4S- `1 <br /> I t'3 1117--1108 A5 /5(-,. <br /> - <br /> -39 : 3 -- , <br /> Transporter - Dae Received Initials <br /> Laboratory Da e R ceived Initials <br /> ChevronTexaco Energy Research & Technology )1 <br /> It is the shipper's responsibility to ensure Federal DOT regulations anA 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 />