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❑ Yes <br /> Fax copy of Lab Report and COC to Chevron Contf. ❑ No Chain--O '�'CUSfiOd CC4r� <br /> 9-1848 Brett litsnter <br /> Chevron Facility Number Chevron Contact (Name) <br /> 1257 Yosemite West, klanceca (phone) 510 842--8658 ` <br /> Faculty tiddrerr / „�� <br /> Chavr*n U.S.A. Inc. 15-0 C8 Z S-,Y"� Z Laboratory Name <br /> Consultant Project Number <br /> P.O. BOX 5004� 945 consultant Name BLAINE TECH SERVICES INC. Laboratory Release Number 36'3 2 7 <br /> i <br /> San Ramon, 985 TimothyDr, San Jose Sampler Collected by (Home) �� ✓ZL P� <br /> FAX x(415)842--9591 Addruer , <br /> project Contact (Nome) 5 <br /> Jim Keller Collection Bate <br /> (phone) <br /> (408) 995-55 fax Number)(408) 293-8773 Signature <br /> Analyser To Be Perlornied <br /> € e o o ! <br /> <1 ni z ran E 2 0 EF, <br /> e r5 � , <br /> a a •g 1 1 1 d ap.-. <br /> O g� <br /> E a y 1m d $ 0.0 '� c7 Itemorka <br /> 67 b f GJ Jam]HL GC�. <br /> C_ <br /> a a v f <br /> F, <br /> _3 0 � <br /> 7-6 + <br /> f <br /> LC5 68 <br /> Organization Dolefnrna Tum Around lime (Circle Chotoa) <br /> RoIrn ulrh (Signature) organization Date/ihn• ��0 Reos d By (SlpnaturR} r . <br /> a W1 24 Hn <br /> '` organization Date/�ilme 48 We <br /> Relinquished (Signature) organl:otlon Data/Tlme I� 7 Racelved Dy (Signature) g 5 � <br /> 1 <br /> Dat• pie Raolvvod For Laboratory By (Signature) Dols Ibns M Conlrnaled <br /> v ReAnqushed By (Signature) organization &/Z`, ���5 <br />