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806 N Batavia • Orange, CA 92868 CHAIN OF CUSTODOCORD <br /> (714) 771-6900• FAX (714) 538-1209 Date Page of <br /> [ADDRESS <br /> NT 111 <br /> PROJECT MANAGER <br /> 04 +��11��, �d� ��aSV <br /> � � ��1,��w Samples Intact Yes � No <br /> [,� q& Y County Seals Intact Yes No <br /> PH NE NUMBER 16 1 -35W61 Sample Ambient_ Cooled_ Frozen <br /> PROJECT NAME lb& 1 —OZ SAMPLERS (Signature) Same Day 24 Hr <br /> Regular 48 Hr <br /> -7 EfU aIs-r-fcr 10 bur ohi t7,,,eluC, <br /> SAMPLE LOCATION DAT! TIME SAMPLE TYPE NO OF SLISP j <br /> TA <br /> NUMBER DESCRIPTION WATER AIR SOLID CNTNRS CONTESTS <br /> c��� REQUIRED <br /> ''VOA 4�b�-r�� Qom � z4of Mrr��,Ta <br /> VW � T1114 5-rpii <br /> 0if <br /> 10-/MW <br /> -11 <br /> S ? <br /> t <br /> I F- <br /> I <br /> Relinquished by (Signature) Received by (Signature) Date/Time I hereby authorize the peWormance of the above <br /> � A j} � indicated work. <br /> oveRelinquished by (Signature) Received by ab ry for a nalysis Date/Time <br /> (Signature) [r v 19* f t Z <br /> Special Instructions p4�cuer ytJltl lc t'� '� a o 1z <br /> � � VV <br /> )� t� �f'� 1����)rf/ DISTRIBUTION White with report Yellow to AL, <br /> (, Mmg� (� Pink to Courier <br /> i <br />