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Fax copAftf Lab Report and COC to Chevron Cont. ❑ No <br /> Chai <br /> tty n—of-�Cuso —Record <br /> Chevron FodNumber 9-8264 Brett Hunter <br /> 3775 Trac $ V Chevron Contact (Nam*) <br /> Faolltty Address Y � Tracy, (510) 842-8695 <br /> Chevron U.S.A. Inc. 9-70SV� (Phone) <br /> P.O. B07S 5004 Consultant Protect Humber Sequoia <br /> Blaine Tech Services. Inc, Laboratory Name <br /> San Ramon, CA 94583 Consultant name Laboratory Releoae Number. 9033908 <br /> FAX (415)842--9591 n�tdrese 1680 Rogers Ave. , San Jose, CA 95112 M-�ATo11 <br /> Samples Collected by (Name} <br /> Prefect Contact (Name) Fran Thie -t� <br /> Cotloot[on Data <br /> (Phone)408-573-0 555 (Fax Number)408- 573-7771 Signature <br /> Analyses 7o Be Performed <br /> y e C DO NOT BILL <br /> FOR TB-/LB <br /> <n 'SOS a 3 <br /> rk <br /> Z a 'f; b it r a p�$ 8 g 0 n <br /> lav Q. 1- U _ 2 e c <br /> p q�,10 * R FQ a'w bn '�� �0 (ru�[r. ,�U 4 0 'V _7 <br /> E b 9 0 Du� O �� AY nrr A <br /> y� o a x�oro y�,,ro 4� -.a <br /> ZI v f] Remarks <br /> ti UP Lo % Hca- Y X k x x X k <br /> ICe5 <br /> S Z X <br /> t <br /> 1 <br /> t <br /> r <br /> i <br /> 1� <br /> s <br /> r <br /> S <br /> . t <br /> Relingvishsd (51pnalun) Organization D te/71me Re d <br /> r or anizatlon, Dote/'nme / Turn Around 11me (Circle Choloe) ' <br /> �� s <br /> 2s Hn. <br /> uleh (Sign Organization ?haat@ me Received Dy (Signature) orgonlzatlon Date/The 40 Hre, } <br /> O !-� t <br /> rte--- <br /> 5 Day* � <br /> \ed By (Signature) Organization — Date/71mo Hecleved 1 or obU!/y D ''1 nature 10 Daye <br /> Y (�4 ) Daternmo <br /> Aa Cantraoted �� <br />