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I ' 0 goYes /� � <br /> Fax copy of Lab Report and COC to Chevron Contact ❑ No f U� Chain-of-Custody-Record <br /> Chevron Facility Number 9-8264 Chevron Contact Name) Brett Hunter <br /> Chevron Products Co Facility Address 3775 Tracy Blvd , Tracy (Phone) (925) 842-8695 <br /> IP 0 BOX 6004 Consultant Project Number '212D - Laboratory Name Sequoia <br /> San Ranson, CA 94583 Consultant Name Blaine Tech Services, Iric Laboratory Service Order 9144488 <br /> FAX(925)842-8370 Address 1680 Rogers Ave , San Jose Laboratory Service Code ZZ02790 <br /> Project Contact(Name) Scott Boor Samples collected by(Name) c4 t y ke <br /> (Phone) 408-573-0555 (Fax) 408-57�-7771 Signature <br /> State Method ❑ CA ❑ OR ❑ WA ❑ NW Series ❑ CO. ❑ UT Remarks <br /> U <br /> ¢ N <br /> N <br /> y L 0 C '� S <br /> m QU o o N - <br /> x i17 <br /> U <br /> w 2U F- Q U C m O ZD _1 <br /> p N + + (D O Ol 0 IL C z [ <br /> C] WO U1r fl 0 [6 Q N <br /> Z o ai m EL m 'm � as v N U m tU t <br /> a x°3 n Xo Xo � n mo mo mo mb co N Xo � x 1 <br /> U 2 al <br /> r ro t= �ro CU II it !Lr N U1 N r T to a)r m r- N N N Lor N W N <br /> MQ ro n. w xN � o � N XN - m � E- o 1- � Q a LabSampEeNo <br /> co EL t- m w " o � Zv w3 m3 f- >- <br /> dL <br /> F•IC I <br /> o"L-c i 7 <br /> / CIcl �t x <br /> 1� �/� "7 G Y ,\ / <br /> S <br /> o <br /> URel uild y Signature) Organization Dat IT rme f ecus ed ( a ��- OSganszation DatelTime ced Y!N Turn Around Time(Circle One) <br /> CM <br /> � ql �tr7`? � 2 e �C� �� 24 H rs <br /> 52 Re cashedBy tore) Organ¢atian Date i Rec�ye <br /> J�ived/By�(Signature) Organization to sme q Iced YIN 48 Hrs <br /> o �0 l.f [ 5 Days <br /> oetrnq�ished By{Signature) Organization DatefFime Received For Labor tory By(Signature) Datefrime Iced YIN 10 Days <br /> As Contracto- <br />