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California Water Labs, Inc. <br /> P.O. BOX 4249 <br /> 1430 CARPENTER LANE-SUITE G <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 <br /> Purveyor I3U r G m _ -47362 <br /> - lab I.D.D <br /> Street lqr (l %Z C �Wa\l Purchase Order <br /> City S OC 1(,) (�(TMZip Referring Lab <br /> Sample I.D. Date Collected _ <br /> Collected by: CgpdYfjU �� k- 5L OC <br /> --------------------------- --- =�-'�- -� '--- --- -- -- ------ ----------- <br /> EN�p 0� sEa <br /> Date Received <br /> Date tarter <br /> �`\ ate Sleted7 By. 7 1! <br />