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AMOMWEMKOWTOWS IF M r M M M M M <br /> 806 N Batavia o Orange CA 92868 Q / CH NOF CUSTODWECORD <br /> (714) 771-6900 0 FAX (714) 538-1209 O f <br /> Date Z3 Page ( ot�.,� <br /> CLIENT Gv(e �� p� <br /> ADDRESS ��� �" �J L�1 7Q V PROJECT MANAGER <br /> ye)g,(— �t � Samples Intact Yes No <br /> ZAR <br /> gb},�� County Seals Intact Yes No <br /> G > Sample Ambient_ Cooled— Frozen <br /> PROJECT NAME (Slgnat a Same Day 24 Hr <br /> Regular 48 Hr <br /> SAMPLE TYPE <br /> SAMPLE LOCATION TIME NO of SUSP <br /> NUMBER DESCRIPTION WATER AIR SOLID CNTNRS COPITAM REQS ED <br /> /,6 py�w-/ i' L� 3 <br /> c G r+ J it ti <br /> -s�ylg t4 e, <br /> ef <br /> A) <br /> ReII qu ed by ( ature) Recel Signature) Da /Tome I hereby authorize the performance of the above <br /> ,�� indicated work <br /> Ur° <br /> Rel quashed by (Signature) ffeolved by Laborato f :-angl�yisignature) Date/Time <br /> Q� l ��s <br /> Special Instructions 1 <br /> DISTRIBUTION White with report Yellow to AL, <br /> Pink to Courier <br />