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77 1117 Lone Pali Venue <br /> ti` = Modesto,CA. `: s`S <br /> A S S O C I A f E 5 <br /> Company Name: rC 11]�4��g��5 ��� Project Name` C V401'\ <br /> Mailing Address: f l J 7 y� / F� Billing Address (if different): <br /> City: MOAU f-o State: C Zip Code.--7535 --- <br /> Telephone: 7ZC, `S`19-Z,.z l FAX 11: fit)9 -5-TJ-ZzZ_ P.O. #: <br /> Report To: kN Sampler:A�� (7 Y-e—S CC Data: evel D (Standard) U Level C U Level B U Level A <br /> Turnaround >4c1_0 Working Days U 3 Working Days U 2 - 8 Hours U Drinking Water Analyses Requested <br /> Time: U 7 Working Days U 2 Working Days U Waste Water <br /> U 5 Working Days U 24 Hours U Olher <br /> Client Dale/Time Matrix # of cont. Comments <br /> I.D. Sampled Desc. Cont. Type Sample # <br /> AM <br /> 3. <br /> 5. <br /> 6 <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Relinquished By: DaleQ`r 1z3'�� Time:1.536 Received By: Date: /$'$ Time: Is-3 a <br /> Relinquished By: Date: Time: Received By: Bale: Tirne: <br /> Relinquished By: Dale: Time: Received By Lab: Dale: Time: / <br /> Were Samples Received in Good Condilion? U Yes U No Samples on Ice? les U No Method of Shipment r� t a /ge i of __/_� <br />