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• i <br /> Fax c* of Lab Report and COCChevron � El Yep e <br /> p to Contact; Cl No ChQI gin—of--Cusfod —RecorC <br /> Cho on Faculty Number 9-191$ Brett Hunter <br /> Chevron Contact (Name) <br /> Chevron U.S.A. Inc. foonity Address (Phone) (510) 842-8645 <br /> P.O. 60X 5004 Consultant Project Number Sequoia <br /> Laboratory Name <br /> Consultant Nome Blaine Tech Services, Enc. 2642370 <br /> San Ramon, CA 9458 985 Timothy Dr. , San .lose, CA 95133 Laboratory R•bare Number <br /> FAX (415)842_9591 Addreee snmples Collected b ( me) r <br /> Project Contact (Nome) Jim Keller <br /> C°Ilealion Dot <br /> (Phoney�Q$� -5 5 i 5 (Fax Numb•r)f1 QB_M-3 81J-1— signature <br /> • <br /> Ano"se Te Be Performed <br /> DO NOT BILI. <br /> xis rr >t {x� g o � <br /> tae II. 1^ � V p • � � • <br /> orOR <br /> a 3 o# c�Vo 4 r� + F a� c� �a ro a ° <br /> d a e r {• E N 4 au oa gc� °N nb <br /> VF Ir to <br /> x 1n 3r t- � 3{ � ti.�.. �'-' � by �.1 n.`� t�`. �`. �3 <br /> Remarks <br /> ALqt <br /> /YY <br /> (Al <br /> Y <br /> 4 <br /> to <br /> -OF <br /> a R •d By Oryaniratlon Dole/Tlme doed By (Slgno r ) Or onlratlon Dole ms <br /> Tarn Mound Tim• (Circle Chola•) <br /> 24 firs. <br /> Rel hod By St ur 0 e lratlon patl/lime Received fly (Slgnatu( Organization Dale/I7me ttI firs. <br /> 6 Day* <br /> �i Relinquished By (Sign urs) Oroonl:alton Date/Ilms naclwed For Laboratory py (Signature) pale me (�C!�nod <br /> n u/ A <br />