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-lam CHAIN OF. STODY FORM <br /> Chevron Products Com any ■ 145 S. State Calle oulevard ■ Brea CA 92822-2292 COC of <br /> Che ANALYSES REQUIRED <br /> Chevron Site No - _ Chevron Consultant Secor <br /> Special Instructions <br /> Address t p <br /> Chevron Stte Address ��^"` �'t• � �` � � ' <br /> Consultant Contact EI L Y >� ❑ <br /> -�- �^ Consultant Phone No ff a c�xy�4 <br /> Chevron PM _W r ��u.�__ �-�1ar - Consultant Project Noy�_ `"�-'L�r'`� ��� o z En <br /> © O <br /> `� Co M U ¢ oChevron PM Phone No `g�; 'dy - Sampling Company -— ¢ <br /> Sampled Ely (Print) CA40 }} <br /> O d N ¢ h 4 <br /> Sampler Signature o <br /> Z. <br /> z w w r <br /> o aLaboratory ►��- ^�-t '�`� w cd ��tr t7,�}►,,,�1 <br /> Chevron 'ervice Code ZZ02800 a m m o <br /> jf�r.r u, N w <br /> ❑ Const}uctionlRetail Job or Laboratory Address �5� �f���� t.._ .�� ��jr, © LL <br /> [OS1le Assessment and Remediation (SAR) Job Lab Contact _ w��� ��f"^J -- LL <br /> a u a <br /> NOTA Lab Phone N ��- -!1 CD (3 t M r <br /> o m m <br /> r p O m <br /> THIS Is A LEGAL oOCUMENT ALL FIELDS MUST' W m ED <br /> BE FILLED our CORRECTLY AND COMPLETEL Y a a <br /> CL w W w ul w US w <br /> r71 b 8 NOteS/G4�Ients <br /> r-tple Sample Gontainer #of Sampling Dated Preservation <br /> Dea.r1 tion Matrix !Re Containers Time <br /> s991 <br /> -o E <br /> L" o <br /> Y4 C <br /> _ - -01 1'7 <br /> -01 <br /> Date/Time Roll glslje Com a y Datelrirne Turnaround Time <br /> Re nquished lay C� any !W.`1' 24 Hours Standard <br /> ` r <br /> J r7-ol Date/Time 48 hours Other <br /> inquisf 7 By Company <br /> Date/Time R hnquisne Company <br /> g � 0 ,� Sample integrity (Check t}y lab) <br /> DateRlm� elinqu+ ed To Company ate/p+me <br /> Rellnquish;J By Company intact On Ice J <br /> Chevron COC Revision 2 Apn 10 2001 <br />