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Fax cop of Lab Report and CCC to Chevron Co t. ❑ No Cha -- of--CuSf oRecord <br /> Chevron Facility Number 9-o.3119 <br /> Chsvrou Contact (Name) B r l'L L HU11 L L r w <br /> Chevron U.S.A. Inc. FoonnyAddrese_ 1347 S. El Dorado St. Stockton CA (510) 842-8695 <br /> ��� �;.. (Phone) <br /> P.O. 80X 5004 Consultant Project Number GTEL <br /> Laboratory Name <br /> Consultant Home Blaine Tech Services, Inc <br /> San Ramon, CA 94583 985 Tzn1001V Dr. , Scln ,lUst•, CA 951 3 Laboratory Release Number <br /> FAX (415)842-9591 Address Samples r allotted by (Name) gQEi� f3LlcAt-1 <br /> Project Contact (!lame) Jim Keller <br /> Calleollor�-$�ta ` <br /> (PhonQY1 Qj9_9 5—_5_U5_(Fox Number)210 _?9 -E31]-3_ slgna}uro.d _ <br /> Anatysee To Be Performed <br /> o a _ <br /> -C n z� a Z <br /> C° ., v ¢ AO NOT HILL <br /> x � �U Ipj�f:$ z � 2S L a a <br /> o <br /> FOR TB—LB <br /> Mo <br /> o qUq n L +Q our s[ f'o °o (�Vrii !q o <br /> 11 E M 4 • H r7 ay>> OJ oh •7, 1� <br /> ? t3 a e x a) ulaQa �m 1N :1()3 .( <br /> 9 x 3N� F U �?'-' O �v IL�� ll.lV �l� Ute. <br /> Remarks <br /> �-�o 2- W 1022 ) ACL. 7 x <br /> Mme-3 t� 3 .� 10443 x <br /> m-J- E til '' 110 <br /> x <br /> l�0 1 <br /> J <br /> p t L <br /> Q- <br /> a RdingUlshsd (Signature) Orgonl:atlon pale o Rsoelve Sl Halve <br /> M ( 4 Organization D terlme ` urn Around Time (Circle Cholas) <br /> f ?� 6� 2�4 Hre. <br /> Relinquished 1)y (Signature) Organization t rime Recel ed By oturo) Or onlzatlon Dole/Time 4$ }{ro, <br /> � Zr�r , l/�C� t,�• ��-�� 1h�o 6 <br /> Relinquished By (Signature) Organization pale Ilms 10 Uoye <br /> / ��� Rsd od For Laboratory Dy Signa un) pats mq_Q 2 Q <br /> ��� 1� As Controotsd <br />