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O TE�B�T�S M M M ' r M r _ <br /> E <br /> sos N Batavia Orange, CA 92868 y7 OG ? CHAI F CUSTOD CORD <br /> (714) 771-6900 o FAX (714) 538-1209 Ill <br /> r 3 Date Page�` of <br /> CLIENT Ir- Yo V4CM�Z-e l <br /> ��� L�GcC� �� Z PROJECT MANAGER <br /> ADDRESS <br /> t'�";r7 /� �122A& Samples Intact Yes No <br /> �L C v L f( [ County Seals Intact Yes No <br /> PHONE NUMBER (�,i -� —-5 G <br /> Sample Ambient_ Cooled_ Frozen` <br /> PROJECT NAME SAMP E S (Signatu Same Day 24 Hr <br /> Regular 48 Hr <br /> SAMPLE LOCATION DATE FIM SAMPLE TYPE O OF SLISP <br /> NUMBER DESCRIPTION WATER AIR SOLID GNTNRS CONTRM TESTS <br /> REQ IREb <br /> t1 5r P7 ,7 °•`'1-VDD',(TrASU� 1L7 P# <br /> r3o f�' <br /> �' P►�w'�� /Z'3v � <br /> S w'Zy 1 ,fs� <br /> co'V- ) C-A 8RgKe-'^1 <br /> C� iM v/a L <br /> .,f d NE 1/o,4 V j A <br /> +pN VbQ V114 VAAK <br /> n M- <br /> �/j <br /> Eo <br /> 5/7U PVH4-z \V <br /> Rellnq fish d y (Sign tur } Received by (Signature) Dat /Time I hereby authorize the performance of the above <br /> 1 indicated work <br /> Relin fished by (Signature) Received b=Lab6t r an ysi �,Qm1v D to/Time, <br /> (Signature) �/ 1���� � <br /> &62Z 64Y � �/ -7--G <br /> Special Instructions 5'4"I p�� S kF'460 /N TWa 0A16 VA5 14ISSIA14 /0 Rx'"ble, <br /> STRIBUTION White with report Yellow to AL, <br /> z"? ' W5/ '-RF :12 C G c-._, M C J'J 4&qG S /t^ �V ink to Courier <br />