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FEDERATLI ISURANCL , <br /> ® P.O. Box 586, Citrus rieights, CA 95611 <br /> tNt npronatfo CHAIN OFCUSTOI)Y <br /> IHE ASS IIRAPIC F.OF QUA llfE <br /> Novato, CA, i I Digital Drive, 94949 <br /> Phone: (415) 883-6100 Fax: (415) 883-2673 <br /> onsuhant's Name: AEG 1.5 EM\J 1 P_C) f fn E NJ rA-L Name of Insured: DOC7� �riC'L%L�l�'/7) Page of <br /> ddress: I 50 Irlt t_,fT LII, �Cv�� l�USC I�ILL1r Federated Site Location:Syq I "F" Bil" <br /> rd <br /> :o'ect Contact: VU I_r ma Ia R T11J Phone #:9J6/76Z-Z_1�� 1 L.! Fax N: 7C�"78. Federated Coniacl: KC 1�1bf�LL tSC�JJ <br /> im led b )Tint : ti 3�1 �'��� Sampler's Si gnalure: 1' hh7Z 1 oue �� �i <br /> --- -,7)ZZ Fax a: ,.,7Z I"41Z 3 <br /> iipment Method: Consultant Project {t: Federated Claim rX: 63 Z — I GjZ <br /> ,T: ❑ 24 hr ❑ 48 hr ❑ 72 hr Standard(10 day) ANALYSIS REQUIRED Sample Condition as Received <br /> Temperanrre° C: <br /> Cooler N: <br /> N Inbound Seal Yes No <br /> aa� Outbound Seal Yes No <br /> 8W) <br /> ample Description Collection Mt ' Prsv #of PACE Cal(S p� <br /> Datellime soilaalar Cunt Sample N ;fid �¢ COMMENTS <br /> o.w as <br /> F•w Fw <br /> 1D- t3 13.. 11 <br /> fy) LO -z � h, <br /> 3 4c <br /> lG�-l3-�r13 - <br /> fnl,(.o � Jj- <br /> � toc}3 <br /> ol c,v - �:i a 5 1 ly. <br /> mlcl ' ID a4StY. <br /> Relinquished by/Affiliation Date Time A AccrPt9d bylAflil••tion Date Time `"Llitiunal CuFmiFCF11S: <br /> 'JILOALC OtE) per tabel <br /> ltt=l-- <br /> -®r <br /> V J- <br />