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oG E&MBOOffrOWS MM IF r ■■�r M M M M M M M ' <br /> sos N Batavia-Orange, CA 92868 CH7N O CUSTODOECORD <br /> (714) 771-6900 O FAX (714) 538-1209 ( � ��L� <br /> Date Page of <br /> CLIENT IO I ate` <br /> ADDRESS l7 L� �/Y �LS�LE�GPROJECT 19 E <br /> Q( Samples Intact Yes No <br /> County Seals Intact Yes No <br /> PHONE Sample Ambient_ Cooled— Frozen_ <br /> PROJECT NAME SAMPLERS igna re Same Day 24 Hr <br /> i+/z P /Q Regular 48 Hr <br /> SAMPLE LOCATION DATE Tf E SAMPLE TYPE NO OF SUSP <br /> NUMBER DESCRIPTION WATER AIR SOLCNTNR5 CONTAM TESTS <br /> D REQUIRED <br /> 510pP*va <br /> Reh i5h by (Sig re) Received by (Signature) Date/ Mme I hereby authorize the performance of the above <br /> indicated work <br /> Reh quished by (Signature) Received by Lab r �r'anal �s � �n) to/Tim <br /> (Signature) <br /> r,AOF. GV4� C.NtOT <br /> Special Instructions f <br /> DISTRIBUTION White with report Yellow to AL, <br /> Pink to Courier <br />