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)IVERSIFIED ANALYTICAL SERVICES CIIAIN or CUSIOUY REC01U) <br /> NYIRONAIEN I'AL LAaORA'I ORY 3732 W. Century Blvd. <br /> Phone: (310) 671-5346 Bldg. 1 Unit 3 <br /> FAX: (310) 471-7216 Ingiewood, CA 90303 Date: �-- �- Page—L-ot <br /> Project Names I Cd T Wa �JG�-l� vvl <br /> Client: <br /> L--14?C,-jQ ;GcY- e v <br /> Project ManagerS�, Phone <br /> Address: ) ��;. �2 L� y <br /> e 11 <br /> Sampler Sign ture <br /> I <br /> Sample Location Samle- Type No. of `Pests <br /> dumber Description Date Time Liquid _ lair Solid Cntnrs Required <br /> Comp Grab <br /> Retinquish Recd by: Date Time <br /> Reiinqished Recd by: <br /> Relinquished by: Recd by: <br /> Rel inquiahed by: Reed for tab by: 3 #�',t otoA <br /> Method of shipments <br /> special. Instuctions: <br /> � mv 111111111 iiimi 4L M M M M so M <br />