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❑ Yes <br /> Fax A* or Lab Report and COC to Chevron Contact LJ <br /> No Cham-of-Custo y-Record <br /> Chevron Facility Number 9-4275 Chevron Contact Name) Brett Hunter <br /> Chevron Products Co Facility Address 2905 W Ben amus Holt Dr Stockton <br /> � � (Phone) (925) 842-8695 I <br /> P 0 BOX 6004 Consultant Protect NumberLaboratory Name Sequoia <br /> San Ramon, CA 94583 Consultant Name Blaine Tech Services,Inc 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) ,r C-. t Z/' r I <br /> (Phone) 408-573-0555 (Fax) 408-573-7771 signature <br /> r - .mac <br /> State Method ❑ CA ❑ OR ❑ WA ❑ NW eries Cl CO ❑ UT Remarks <br /> U V} <br /> N N Q <br /> Ill Q U O O N <br /> ¢U 4m Q _ c [¢ oZ n m <br /> w + + m �' a] IL C Z C <br /> E w uJ Z o a= O O <br /> LU <br /> Z o m tL ai m m °� U m <br /> m —m m + + _ n a m C7 IL U <br /> CL n L�� a C 4 m .. m m a N L <br /> E E I II E 2 til N UxJ N 2 � �C�o 01O 21ti � M1 ca N m U X O X L] <br /> z 2 U) U11), m m m Imo- 0Q° O N a °�° Q t i °N° O ` U tLimL1 °�° m tom- r° Lab Sample No <br /> � �. Z <br /> I I <br /> `�I�LIi e t3y(Sig <br /> Organization Date/Time Receiv y(Srgn "e) *ORDate/Time 41cedYIN Turn Around Time(circle One) <br /> 24 Hrs <br /> quishegt�y(Si aat'ure� Organization Date/Time Received y( igna ure) Date/Time Iced 48 Hrs <br /> YIN 5 Days <br /> 7[shed (Sig ture) Organization Datt1e/Time� Received For Laboratory >(Signature) Date[Time Iced YIN 10 Days <br /> ��� �� L C;JA— t Z� ��G� ���L As Contracted <br />