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U Yes <br /> Fax copof Lab Report and COC to Chevron Cont: ❑ No Chain--Of--Cu5to Reeor( <br /> Chevron Faclliiy Number Chevron Contact (Nome) <br /> Facility Address (Phone) (9 25) 842-8695 - <br /> Chevron Producls Co, 1404, l3_k—_I SEQUOIA <br /> Consultant Project Number Laboratory Nome <br /> P 0, BOX 6004 BLAINE TECH SERVICE, INC, 9144488 /A/CIO 360 <br /> San Ramon, CA 94583 Consultant Name Laboratory Service Order <br /> FAX (925)842 -8373 Address 1680 ROCERS AVE. SAN JOSE Laboratory Service Code 2202800 <br /> Project Contact (Nome) CHRISTINE LILLIE Samptas Collected by (Name) e'l <br /> rrvlr <br /> (Phone .08-573-0555 (Fax Number 08-573-7771 Signature <br /> State Method, ❑ CA ❑ OR ❑ WA ❑ NW Series ❑ CO ❑ UT Remarks <br /> C <br /> 5 4V Uf{ � a C � Z tj $ <br /> A d. ++ ];a I U .9 _ _ u� <br /> x i 11 113' <br /> as <br /> Lab Sample No <br /> rAW'l 3 W 4041619 IZ30 Y <br /> VA W--L 011 ) )L aZ <br /> MVJ -S 37131119 1210 D - <br /> r�t�-�( 3 qr 1�lr� 04- <br /> 04 w-S 3 1V1 ! 99 Its[ OS _ �r <br /> MW-� 3 W 131 06 <br /> mw-`r 3 W ll Z9 07 <br /> wiw-9 3 <br /> 3 to <br /> T Z VJ V9 I �iB <br /> n Rellnquiahed By (Signature) Organl:oll Dote/7g1ms Rece 8y (Si a re) Or anlzallon Date/Tlme/Y Iced VN Turn Around Time (Circle Choice) <br /> ` ! '� !r <br /> 6 24 lira <br /> i <br /> Rellnqul fed By 51gna#urs) Organization Dote/Tlme Received (Sign r Organlzo n Dote/ me Iced Y/N 48 lira <br /> �� 5 Days <br /> 10 Days <br /> Reiinq e By nature) Organization Dal /Tips J, Reclavad For Laboratory By (Signature) 11 <br /> e Am Iced Y/N As Contracted <br />