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-� 0 • ❑ Yes <br /> Fax copy of Lab Report and CCC to Chevron Contact; ❑ No C ql —0 —�U5 0 — eco i <br /> Chevron ractllty Number 71 BRETT HUNTER <br /> Chevron Con}ac4 (Noma) <br /> Chevron Produels Co. racnily Address 6633 Pacifies„Ave• ,irnrktnn (Phone)(925) 842-8695 <br /> Box 6004 Consultant Project Number�I0S l`t —C Laboratory Name SEQUOIA <br /> P.O. BLAINE TECH SERVICES INC ', �— <br /> Consultant Name _,,__ <br /> San Ramon, �� A4583 1680 Rl7GERS AVE. SAN JOSE Laboratory Service Order _c11 Gl.tr.g.$_.. <br /> FAX (925)042--0370 Addrass Laboratory Service Code <br /> r <br /> Project Contact (Nome) CHRISTINE LILLIE Sample# Collected by 'I'V R vtN.. k-- <br /> (Phone) 408-573-0555 (Fax Number} 408-573-777-1 - Signature <br /> State Method: ❑ CA ❑ OR ❑ WA ❑ NW Serles ❑ CO ❑ UT Remarks <br /> doSIR A <br /> 1 �} �^ <br /> (k` I A �, Lab Sample No <br /> 3 � 1 S � tl° 7�` <br /> TSD <br /> 16 ( D — <br /> 7 <br /> 1-1 -A I I <br /> 9y�((Slg�nalurs) Orgonl:allon Oale/Tllms Reee�l d 9y gn�) Organization ��Ime ��Z load Y/N Turn Around Time (Circle Choice) <br /> �/ 24 Nra. <br /> (S`(gna )) orgonl:allon oala/Rms Received By (Signature) Organ lion bate/Time load Y/N 4B Fire <br /> / 6 pays <br /> }0 O_ya <br /> Sgnature) Orgonlialion Oate/Tlme Recleve}d�For Laboratory fly (Signature) Date/time load—y)" As <br /> Can <br /> lraEled <br />