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I <br /> • U Yes <br /> Fa of Lab Report and COC to Chevron Contac • .�, <br /> Pv P N� ChgIn�-of Custod -zRecoi <br /> Chevron Facility dumber 9-0557 $RETT HUNTER <br /> Chevron contact (}some) <br /> Facility Addraoa t Stockton (Phone)(925) 842-8695 <br /> rP <br /> evron Pradl}cls Co. � o ,Ni) <br /> 0 BOX 6004 Consullanl Project Number d Laboratory ManiaSE4UOIA <br /> Coneullanl Name BLAINE TECH SERVICES,__INC. Laboraia <br /> San Ramon, CA 94583 Address 1680 ROGERS AVE. , SAN JOSE ry Service order _tLLl+ll1�.8.8__ --- <br /> FAX (925)842-8370 Laboratory Service Code ZZ02800 <br /> Project Contact <br /> Pro llama CHRISTINE LILLIE ^117,-C I <br /> � ( ) Samples Collected by (Nam) <br /> (Phone] 40$-573- 0555 (Fax Number) 408-573-7773 Signature , <br /> State Method: ❑ CA ❑ OR ❑ WA ❑ NW Serles ❑ CO ❑ UT Remark$ <br /> N N fix�,,i rd a aqa� <br /> to 0 <br /> a a uto <br /> L7 C <br /> E <br /> y Lab Sample Na <br /> C) <br /> —_ <br /> M~S <br /> T--(z% <br /> Use <br /> TB <br /> X <br /> U <br /> �sllnqulehed By(Signature) Organlzallon Bale/Tlmer a Regie 010 By ( ure) /!' Organization Data/114 lead VtI Turn Around Time (Circle Choice) <br /> _ yrs <br /> 24 Hrs. <br /> q Ret} hod Slgnalura Organization Date/Time Recelvad By (Signature) Org ration Bale/Time Iced Y/H 9S Hra. <br /> ZiJ� �/� i e% '. � 3 Gaye <br /> C 10 Days <br /> v Relinquished By (Signature Organizallon Data/Time Raateved For (aboralory By (Signature) Data/Tama feed Y/N As Contracted <br />