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L MAW4 OF 1,U51UUY 1-UHM iuvy� <br /> Chevron Products C rnpany ■ 145 S. State Colle oulevard ■ Brea CA 92822-2292 COC _of <br /> Chevron SiteqW Chevron Consultant Secor ANALYSES REQUIRED <br /> Chevron Site Address Address Special Instructions • <br /> ,A Consultant Contact Tlstz:4� "&U, g <br /> lI' Consultant Phone No 116 -� —O Yo� <br /> yy w Ise ❑ LUr ,,, ` <br /> z t�-r' t! <br /> Chevron PM + 1 u Consultant Protect No 0 7 Z .}% <br /> Uy <br /> Chevron PM Phone No ��� -1(aI -OV00 Sampling Company �(--Lp � M ° < o <br /> Sampled By(Print) SGS.- Coy,U-- � � ❑ o M p co <br /> Sampler Signature Q W W 5, <br /> Chevron Service Code ZZ02800 LaboratoryCq <br /> ,� © ❑ #�x 41����� �' <br /> ❑ <br /> Construction/Retail Job orLaboratory Address a L' ' �� ~ Y W ° <br /> 53Slte Assessment and Remediation (SAR) Job ��5� El w <br /> Lab Contact _ �a,n r uGt an�7 _ = u. o ❑ _ <br /> NOTE p a y h <br /> Lab Phone No <br /> THIS IS A LEGAL DOCUMENT. ALL FIELDS MUST `r' N 8 o o co <br /> BE FXLED OUT CORRECTL Y AND COMPLETEL Y co � � ( r L � <br /> N <br /> a ¢ ¢ <br /> � w w uai W w � w <br /> Sample sample Container #of Sampling Date/ Preservation Notes/Comments <br /> Description Matrix Type Containers Time <br /> --1-LA 1441 <br /> ' CP7 - <br /> G 5 0� <br /> _ y - 3p -0� <br /> Li 1-3 <br /> CPT- q - 60, <o� <br /> - <br /> o' v <br /> . 4 - (o& 50 <br /> Relin +shed <br /> 74 Company Daterr+me CA, n ed To C pany Date/Time Turnaround Time <br /> D- -o 1200 Y �! ,-�,,-`1 24 Hours Standard <br /> . ] <br /> Relinquished By Company 7 Date/Time Relinquished T Co panya 0".;%'4 A�V a)A r'A J ri Date/Timi•'euL� 48 hours Other <br /> O Sample Integrity (Check by lab) <br /> Relinquished By Company Date/Time Rel nquishe o Company Dae ime I <br /> Intact On Ice <br /> Chevron COC Revision 2 April 10,2001 <br />