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0 • <br /> f. Date and time: <br /> Name: <br /> Affiliation: <br /> Telephone number: <br /> Address: <br /> Information provided: <br /> Instructions received: <br /> 13 . Samples taken? Yes/No <br /> a. By whom: <br /> Time: <br /> Date: <br /> Number of samples: <br /> Specify sample type: water/soil <br /> Where were samples taken? : (Describe location and specify distances . ) <br /> 8-6 <br />