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O EMBMTO%S " ' _ v G- _ _ = —DECOR <br /> 8D6 N Batavia•Orange, CA 92868 <br /> 5CHAT OF CUS O <br /> (714) 771-6900• FAX (714) 538-1209 Date Page of <br /> 1 ' <br /> CLIENT- <br /> MAN4GER <br /> ADDRESS +��G` GG_ �� ���jL - Samples Intact Yes No <br /> - <br /> County <br /> PHON <br /> % 6 Z E NUMBER .., County Seals Intact Yes No <br /> 21Q Sample Ambient_ Cooled.,.,_ Frozen_ <br /> PROJECT NAME SAMPLERS (Sin ure) Same Day 24 Hr <br /> Regular 48 Hr <br /> SAMPLE TYPE NO Or SUSP <br /> SAMPLE LOCATION DATE TIME CNTNR i CONTAM TESTS <br /> NUMBER DESCRIPTION WATER AIR SOLID REQUIRED <br /> pock tAuj I 5 or- il� tf C t H a M c } 15100 ?66M&N10 <br /> /x- <br /> TyuaV°.tj Y <br /> S�CI�IMw� <br /> VO4 V JA+ ' CIV <br /> i S'�GJG�hw� � vfl <br /> �'/'fjG�L f'Yl rtir/ <br /> %�dd v lA 1 R k r/ 1 36 <br /> Reli q he y ( g tura} Received by (Signature} Da /Time I hereby aut onze the p rformance of the above <br /> dlCated work. , <br /> Reli quished by (Signature) Received by4Lab or ana ysis �/�J Date/Time,���a <br /> (Signature) ����� � �G � <br /> U .� /Y� �' a <br /> Special Instructions <br /> r/ DISTRIBUTION White with report Yellow to AL, <br /> Pink to Courier <br />