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yll/1��9 yi Veld!V0I1 eIA:VV/l!I <br />Client �• <br />Prged of p0/ • <br />, Aea*eu raWred <br />� � � r,L � �i .. <br />� `�� � '•.":��. ~ <br />y4 : V ® $ <br />y` r�` .�. f. ' �*V., y� �• �%;�. !� �% J+�.•� <br />,/ W* . • N " V <br />Address <br />Phone / <br />city. states <br />Y. p <br />Re attent - <br />Lab <br />Sample <br />number <br />Date <br />sampled <br />Time <br />sampled <br />Type• <br />See key <br />below <br />Sampled byr^ s �s <br />r '�` Number <br />' of <br />Sample descriptioncontainers <br />it <br />''d <br />x <br />W <br />� <br />O <br />all <br />O <br />3•t'X� <br />I <br />Signature <br />Print Navm1 ee <br />Company <br />Date <br />Time <br />Relinquished by <br />el�V <br />�� <br />j �e <br />Relinquished by <br />Received by <br />Relinquished by <br />Received by Laboratory <br />B C ANALYTICAL a Now Samples are discarded 30 days after results are reported unless other arrangements are made. 'KEY. AO—Aqueous NA—Nonaqueous SL—Sludge <br />1255 Powell Slreet, Emeryville, CA 94608 (415) 428.2300 <br />Hazardous samples will be returned to client or disposed of at client's expense. GW—Groundwater SO—Soil OT—Other PE—Petroleum <br />❑ 801 Western Avenue, Glendale. CA 91201 (818) 247.5737 Disposal arrangements: <br />❑ 1200 Pacifico Avenue, Anaheim. CA 92805 (714) 978.0113 <br />