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LiI <br /> No <br /> Chai —of -Cusfod oecord <br /> Fax copy Lab Report and COC to Chevron Contac . 0 No <br /> Chevron Fadlty Number 9-1848 Chevron Contact (Name) Brett �IuntCr <br /> Faolllty Address 1757—To etulte est, Manteca (Phone) (510) 842--8658 <br /> ,_ <br /> Chevron U.S.A. Inc. 760 gz z -,g3 _ G -T, <br /> P.O. BOX 5004 Consultant Protect Number Laboratory Name _ <br /> Consultant Name BLAINE TECH SERVICES INC Laboratory Rsleose Humber -35 3 -Z 7 <br /> San Ramon, CA 94583 985 Timothy Dr, San Jose ��--• �� <br /> FAX (415)842-9591 Address 985 Collected by (Name) <br /> Protect Contact (Nome) Jim Keller Colleotlon Date <br /> (Phone) (408) 995—553 „ Numbar)(408) 293-8773 Signature -" <br /> Anoiyess To Be Performed <br /> o <br /> ]� Fa .- I <br /> jS Y t V c913 r o a 0 <br /> E p a 000 on vo c- <br /> 19 <br /> o �� 94 a °e E: '� O a0 a N �� Sco ^E 0 °9 z tn� r= � �`, o`, nac Remarks <br /> C Z /Y2o x <br /> C - 3 ( 3Sb x <br /> I <br /> n t <br /> s <br /> i <br /> Relinquished By (51gnoturs) Orin Dat /funs Re o d (Signatur Organization Date/Time �� Turn Around Tlme (Circle Cholos) <br /> 24 We <br /> Relinquished By (Signature) Organlzotlan Dol•/Ilme���] RecoNed By (Signature) Organizot on Date/Time �_�� 48 tire. <br /> s I <br /> Rsllnqul•hed By (Signalurs) Orgonlzatlon Dal•/Tlme R•oleved or Laboratory By (SI nature) Dote me (A-10,n ot.d <br /> �(D r <br />