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 3 <br /> Contact: Grace Chen 510-242-5918; Michael Moir 510-242-1634; Rachel Mohler 510-242-4939 <br /> Chevron PM: t Scott Mansholt(925) 543-2353 ❑ Lee Higgins (925) 543-2365 ❑Other: <br /> Company, Department EMC Bus. Unit, if applicable Chevron harge Code NWCRL00003M20} <br /> Chevron Environmental Management Company SFSP i� 77A <br /> Address: 6111 Bollinger Canyon Road, San Ramon, CA 94583 <br /> Project M nager(s) E-mail Phone <br /> crw <br /> Company, Address:❑ SAIC, 3800 Watt Avenue, Suite 210, Sacramento, CA 95821 SAIC, 1000 Broadway, Suite 675, Oakland, CA, 94607 <br /> ❑ <br /> AM EC Geomatrix, 2101 Webster St., 12th Floor, Oakland, CA 94612 4ARCADIS, 2033 North Main St., Suite 340, Walnut Creek, CA 94596 <br /> Sampling Loc tion (e.g., Street Address, City, State) Site Name (e.g., Alden Park) <br /> 11 <br /> PIPELINE: [] Chevron (O 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 /> Name Sampled Containers (e.g.,soil Fingerprint Analysis <br /> or water <br /> 5a pled By (Print Clearly) Relinq ed Date & i e) 7161Q ]nitials <br /> TranspMer,4Print Clearly - Rec (13de & ime) Initials <br /> LabofReceived (D to &Time) Initials <br /> 'at ry <br /> Chevron Energy Research &Technology <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 />