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Fax co of Lab Report and COC to Chevron Co Act U No Chaim---Of`-'CuslQ —Record <br /> �uu un..�in�nwo n�rrrrmnnn.ra.e.rr.a�.rr.rrr <br /> 97275 <br /> Chevron Facility Number Chovron Contact (Name) BrcLL 11MILer <br /> ja <br /> Facility Address 2905 W. Benmin 11o�t_Dr , Stockton (Phan.) (510) 542--8691 <br /> Chevron U.S.A. Inc. rf5ocl Al <br /> P.O. fox 5004Coneukanl Project NumSer. R �, . . Laboratory Narnd f:Tl'T„:„ <br /> consultant Name Blaine Tech Services, Inc. '� 3532830 <br /> San RamnR, GA 9583 985 Timothy Dr. , San .Jost-, (:A 95153 �/ Laboratory �.lea.. Number � � <br /> * /Wdreee Snmplee Coll* by (Mame) QA N p Vr i-•�1�1`' I h)E <br /> FAX (4 1 0842-959 t <br /> Project Contact (Nome) Jim Keller ✓ Colleothm Da � ` t- C, <br /> (Phona}rkQ�'�_S�a�_(Fan � Slgnolur* �' ^� <br /> Analyese To Be Performed <br /> • `"�— Do NOT BILL <br /> 2� wee <br /> r <br /> 0 Er _ f 17DR TB-1..11 <br /> 111 x 1 V ° a <br /> z a o I`- v o e 14 <br /> *o O� tiN ro �ry YJ �n ^n' a <br /> a <br /> E A E 11 <br /> x (Or r F' cK u kyV° <br /> i <br /> r o1 <br /> 02� <br /> MW-3 <br /> MfNr7 <br /> CIS w 131 } C <br /> o w G 1300�T -- <br /> _ 1 <br /> 7 0-7 3 1 )1� <br /> c W G-7f 11V Y <br /> w <br /> Cq G [ ZC--, <br /> R quiehed (5! of <br /> Organization Date/Time � Reaeiyed by (Slgnatur.) Organnholltlo^n Doto/Tlme Io C� Tum Around 11ms (Circle Chola* <br /> .� <br /> '-75 U` �� I�� q -3 yam— 24 1Irv. <br /> Relinqule ed (Signatur Organization Daro <br /> r �o Reca ved Ry (Signature) Organization Dals/Tlma 48 lire. <br /> = V 6 <br /> — 10 Day. <br /> Relingvbhed By (Signature) Organization note/nme Ileefev*d For Laboratory Ely (Signature) Dol /Tlmo A. Gonlraoted <br /> l7_ G <br />