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CAS7W ANALYTICAL LABORATORY y 7 ae)Jpr_. -a-7 CHAIN OF CUST <br /> Location: 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No. 2079 <br /> Mailing Address: 2333 Shuttle Drive, Atwater, CA 95301 PAGE -- OF <br /> Phone: (209) 384-2930 - Fax: (209) 384-1507 <br /> Customer: f k1c.2 1 . ..0 1 )111. REQUESTED ANALYSES ' Method of Shipment: <br /> Address: 0 <br /> City/State/ZIP: o a Notes: <br /> Phone 1 FAX: W a �Lu m a <br /> Proj # IP.O. #: { rFj� i LL) Iyl^ a " W � a Co o a U <br /> Report Attention: Y W g F a. a <br /> Sampler Signature: g g m <br /> Printed: <br /> 'z <br /> Lab ID# 1 SAMPLE ID DATE TIME DESCRIPTION&OCATION OBSERVATIONS/REMARKS <br /> til -4 1 . <br /> I y <br /> Akh)-Mix <br /> fie <br /> I <br /> i Total number or containers submitted to <br /> Signature Printed Name Date Time Company Name the laboratory <br /> yVij <br /> Relinquished by. !' C C�5 f Note:All special requests(e.g.quick <br /> y � U�n�Iee J T�s OBStJ �Q tum times)must to cleared through <br /> Received b authorized laboratory personnel. <br /> Relinquished by: <br /> Received by: AiAT <br /> UIM <br /> Relinquished by: RESULTS DUE: <br /> Received by: �� VERBAL WRITTEN <br /> HEAD SPACE ABSENT &eCONTAINERS -rig. M <br />