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CHAIN 04USTODY FORM . 10089 <br /> Chevron Products Company w 145 S State College Boulevard ■ Brea CA 92822-2292 COC =L of <br /> Chevron Site No _ Chevron Consultant Secor ANALYSES REQUIRED <br /> Address 1 Special Instructions ' <br /> Chevron Site Address �-O w,, ❑ <br /> Consultant Contact <br /> Consultant Phone No - � .� w 4 <br /> ul <br /> Chevron PM <br /> Consultant Project No 0 7-7.d�Scr; 1 a�- Z -i '"`�"� i <br /> Chevron PM Phone No �1 `��� 'd`It;k9 Sampling Company E (r a o �}g JD-1 <br /> P+r: <br /> o¢ 0 12 <br /> Sampled By (Pant) ��-- d Y C] l: C3 <br /> r i Z <br /> Sampler Signature = ¢ W ? w �( � �_�,DA i <br /> ❑ ❑ Z lz a <br /> Chevron �'ervlce Code ZZ02800 Laboratory h� „�,t rk � W N z Mr �ol p,�-}•,r�1 <br /> ElConst ucttonlRetail Job or Laboratory Address O5� ��c.�. �� � niiy 0LU <br /> or l <br /> [ZSlte Assessment and Remediation (SAR) Job —'°�' ❑ 0 wL) 11 <br /> Lab Contact rti i.,i f�^� x r u v ❑ F _ <br /> F O w <br /> NOTE - �� -1� i- m a o a ix <br /> Lab Phone No — ca 0 0 a m <br /> TNIs ISA LEGAL DOCUMENT ALL FIELDS MUST a o N o o <br /> BE FILLED our CORRECTLY AND COMPLETELY Co Q a 4 a N a j <br /> ju w w w a- 0.� cin w <br /> S mple sample Container 4 of Sampling Date/ Preservation Notes/Cc . -ents <br /> Des ri tion Matrix Tvpe Containers Time <br /> t --3 of S _ c. <br /> .p _ + 6.01 L Q <br /> - C <br /> YV <br /> _ 1 -off 1 <br /> _o Y-`7 - 53' -ut l4 --' <br /> Re squished 6y Com any Date/Time Reli q s e Com a y Datef ime Turnaround Time l <br /> Sy'Z,.�1,�r ) 24}lours Standard _ <br /> inqulsf u By Company Date/Time R linqu=she / Company ! Date/Time 48 haurs Other <br /> t I� A l g.Lq I# Sample Integrity (Check by lab) <br /> Rellnqulsh:J 8y Company Date/Trm� elinqui ed To Company atelTime <br /> r Intact On Ice <br /> Chevron COC Revision 2 Apn 10 2001 <br />