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s <br /> Fax c*bf Lab Report and COC to Chevron Coact, ❑ Noy Chain—of—Cust —R9cOr( <br /> ` Chevron Facility Number_9-427 5 Chevron Contact (Name) EMT nUNTER <br /> Chevron Protlucb Co, Foclllly Address ) (925) 842,-8695 <br /> Consultant Project Number d (� _�t (Phone) <br /> Name SE 170IA <br /> P.O, BOX 6004 Consultant Name BLAINE TECH SERVICE, INC, <br /> Laboratory 9144488 <br /> San Ramon, CA 94583 Laboratory Servlce Order <br /> FAX (925)842-8370 Addreaa 16$0 ROGERS AVE. , SAN JOSE Laboratory Service Cada ZZ62800 <br /> 1l Project Contact (Nome) CHRISTINE LILLIE_ Samplae Colic cled b (Name) . <br /> 408-573-0555 �+08-573-7771 ; <br /> (Phone) (Fax Number Signature <br /> State Method ❑ CA ❑ OR ❑ WA ETNW Seri '❑ CO ❑ UT Remarks <br /> Il � tl <br /> Nil <br /> ma CL <br /> a <br /> Z <br /> I) <br /> Lab Sampla No <br /> RW 1 r 3 U Nct 3 i;m3 _'Y <br /> cA%.) i� X <br /> lamlilt) <br /> If <br /> _ t - <br /> ��� koto <br /> i <br /> I <br /> r I f <br /> Rel hod lay g lure) Or nlzallon Data/Time ocelved By (S alure) Organization Data/rima l Iced YIN Turn Around Time (Clrele Choice) <br /> rcr 24 Hre <br /> ��A ,n rda ed y I nature} Organlzallon Qale/nlme Received By (Signature) Organization Qole/Tlme lead Y/N 48 hra <br /> 5 Days <br /> 10 Days <br /> ii +lahed By (Signature) Organization Data/Time/ Reclaved F L glory By (SI n tura) Date/Tima } load Y/N Ae Contracted <br />