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L...J 1 4:+ <br /> rax co of Lab Deport and COC to Chevron C*Ct: C] No Chain-of`-CUS� —R@Cor <br /> Chevron Facility Number 9-05-57 --- - — - Chevron Contact (Nome) Brett Ilunter <br /> Faolllty Address 139 South Center St. , Stockton, CA (phone) (510) 842-8695 <br /> Chevron Q.S.A. Inc. Osl �'T 3 <br /> P.O.C}. �ox ���¢ Consultant Project Number- J-�- Loborutory Name Sequoia <br /> Consultant Name Blaine Tech Services, Lne. Iq <br /> SariRaman, CA 94583 <br /> c Laboratory Release Number <br /> Address 985 Timothy Dr, , San Jose, CA 95133 Samples Collected by (Rams) <br /> FAX (415)842-9591 ,- <br /> Project Contact (Name) Jim Kel.l.er. Collection Date — 1I — F � <br /> (PhoneY,08 99 i--5535_,.(rax Number)Iii-293=81.7 _ Signature <br /> 11,f Analyses To Be Performed O f C z <br /> • p DO NOT BILL <br /> Z t o z g g �, o FOR TB—LB <br /> O • <br /> u .-. <br /> 4 x2� 'b � �` <br /> + F °u"i cro no AUUo rqqc�, yO on o <br /> Q, h d 4.- GUNS jQ;, ON p`� Un „ , <br /> A 1 R • r• N 7 b u q 4. �m Cq q <br /> }� f o ry w 5v ��. {,..+ o <br /> L% S x en�r , u`{ 1.— ILV O n n. Remarks <br /> w- 3 W7 <br /> o7 -� <br /> t - - <br /> - 3 <br /> - S <br /> L <br /> j Rel gulshed (Sl tur Organization Dole./time <br /> 1q10 <br /> Received By (Signature) Organization Da� mo Turn Around Time (Circle Choice} <br /> / c <br /> 111 _��Qt,pl✓ — -- 5 / /(C� 24 Nrr. <br /> >a Rsllnqulshed (Signature) Organlzatlon Date/Tlme Rocelve Dy (Slgna rs) 48 Nn. <br /> C:: <br /> Day. <br /> Rsllnqu ed By (S nature) Organization Role me Rocleved For Loborolor y nature) Dal /Time ntrooted <br />