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Fox copy of Lab Report and COC to Chevron Con ct. ❑ No Cha --ofCusfo —Record <br /> Chevron Fat1111y Number — � I3reLt lluilLer Chevron Contact (Name) � <br /> Chevron U.S.A. Inc. <br /> Foontty Address— 1h7 S El Dorado St , Stockton, CA (phone) (510) 842-8695 <br /> _l Consultant Project Number v 92 �awm/< Lobaralory Name GTEL <br /> P.O. eox 5004 Consultant <br /> San Ramon, CA 94583 ros Nome Blaine Tech Services Inc. <br /> 1lddrese 985 Tirnutlly Dr. , San .losr, CA 9153 l.aborolo�, Release Number <br /> FAX (415)842-9591 Samples f allotted by (Name) <br /> Project Contact (Nome) Jim Keller Colleotlon Dale <br /> (PhoneyJ02 995---5-53.5—(F'ox 14umb.r)-408_2,9-3�81-73_.._. Signature *11 <br /> gpQY Ano"a. To Be Performed <br /> Lv Y " Do NOT BILL <br /> 11 U <br /> 01. L V <br /> oFOR TB—LB <br /> � ki <br /> r.E A } Z I O N U O,( trC, .4 aN� r ; au �w <br /> Remarks <br /> � 3 s <br /> r — <br /> 4 <br /> t <br /> `h <br /> v <br /> a Reflnqu 1gn Organization Date/firno S RecoNedd}Dy (Slgnolure) Organization Dale/T1msltq Turn Around Time (Circle Choi**) <br /> 619 24 Nre. <br /> d <br /> Rel qulehed By, (Signature) Orgonlzatlon Dale/Ilme ReceNod By (Signature) Organlzatlon Dale/lime 48 Nre. <br /> � u,�..�-t E C�.i�� 8►� is <br /> t o Doy. <br /> Relinquished By (Signature) Organization Date/time Rso1��Loboralory Dy (Signature) Dale/71me Ae Conirooted <br /> 702 650 2475 <br />