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Fax A of Lab Report and COC to90 Yes � 4- <br /> Chevron Contact ❑ No Chain-of-Custody-Record <br /> Chevron Facility Number 9-1848 Chevron Contact Name) Brett Hunter <br /> Chevron Products Co Facility Address 1257 Yosemite Wy,, Manteca <br /> A d BOX 6004 {Phone} (925) 842-8695 <br /> Consultant Project Number <br /> --111 A Laboratory Name Sequoia � <br /> San Ramon, CA 94583 Consultant Name Blaine Tech Services, Inc <br /> Laboratory Service Order 91444$$ <br /> FAX (925)842-8370 Address 1680 Rogers Ave , San Jose <br /> Laboratory Service Code ZZ02790 <br /> Project Contact(Name) Scott Boor <br /> Samples collected by(Name S t <br /> (Phone) 408-573-0555 (Fax) 408-573-7771 Signature <br /> State Method EJ7 ❑ OR ❑ WA ❑ NW Series ❑ CO ❑ UT <br /> W m N Remarks <br /> QU <br /> u ti EL U) <br /> oQU m + °o CQ7 ov m oz a m <br /> U W + y m 2) O N Q c Z c <br /> Z a `m a. m m y ai m a) U N W q `x <br /> J3 x a + + ?� c q O Q F- U W <br /> E j S u) E W N X O ❑ i p�i 41 p Ql q [ N w Z ❑ <br /> uJ N 2 y,to arm rntiX CN � a mU Xo x o <br /> Z �cn N q Co m Fc- m O co a ° 04 <br /> o a. a? Cli wa. <br /> n °' F- LU 04Ta. z <br /> _ O " r° M m t' Lab Sample No <br /> �-- 3 ftct 111 �( <br /> c- i - s77 <br /> a p1 G <br /> 02-02-GNU d3 <br /> i <br /> z <br /> Relinquished By(Signature) Orga ization Date/Time Recet�dd B (Si <br /> Or anizaGon Date�ma Iced YIN Tum Around Time(Crccte One) <br /> 5 f rL I, U�.�.'� �OQ I- <br /> Rein ed (Si Organization bat r Receive 24 Hrs <br /> nature) Or anization Datefrime Iced YIN 4a Hrs <br /> oReh gars d rg re ' Org�aiz�tron tate rme Received For Labor to B (Signature) Date ime $Days <br /> �,/� Iced YIN 10 Days <br /> Jf. As Contracted <br />