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tb y 3y � <br /> CHAIN OF ATONY o Pae 7PT7 <br /> CONSULTANTS NAME GONSU!TANT S ADDRLSS <br /> Blaine Tech Services, Inc 1680 Ro ers Ave , San Jose CA 95112 <br /> BP SITE NUMBER BP SITE!FACILITY ADDRESS CONSULTANT PROJECT NUMBER <br /> 11193 3202 W Hammer Lane, SIOcklon Q _S <br /> COIISUI TAUT PROJECT MANAGER PI LONE NUM13EH FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> Morgan I lar rave 408 573-0555 x 218 408 573 7771 J265304 <br /> {3P f OEITACT BP ADDRESS PI ZONE NUMBFH FAX NO <br /> Scott I-loolon 295 SW 41st Street, Suite N, Renton WA 425 251-0689 425 251-0736 <br /> I AB CONTACT I ABORATOHY ADDRESS PHONE NUMBER FAX NO <br /> Pace Lily Bayati 3970 Gilman Street Long Beach, CA 562 498-9515 562 597-0786 <br /> BP CONTACT nFO1JFSr1l IG RUSI I 1 AT(Pnnl BP Conlacl Name} HUSH HEQUES]ED OF(Print Consultant Contact Name) DATEITIME SHIIPMENT DATE SHIPMENT METHOD <br /> TAT ❑ 2a 1IOURS ❑ 413 11OUHS ❑ 72 HOURS ❑ St-,.d,.,,)7 or 5 t Days ANALYSIS REQUIRED AIRB ILL NUMBER <br /> [WIIAII)ER5 PRESERVA114 <br /> m <br /> M r„ o <br /> SAE WI E DESCRIPTION <br /> COI 1 ECTION COI I ECTION MAI RIX ¢ $ <br /> DATE TIME SOILIWAILR NO TYPE IAB w m u om COMMENTS <br /> (VDI) SAMPI E a M x w <br /> o _ a <br /> x ; a <br /> X <br /> U 1 vv <br /> �- jazY G L <br /> O o c. <br /> //so E- <br /> /1/S VI/ M L' <br /> SAI 1111 ED BY(Please Print Name) SAMPI 117 BY(Signaluro) ADDITIONAL COMMENTS <br /> f <br /> F t INOUISI IED BY/AFFII IATION AGC1I11 ED BY I A FII IAI ION (Print <br /> (Pant Ilame)Signature) DATE TIME Namo I Si nature) DATE TIME <br /> —_ WOLI N4 <br /> S io 170 U .UU <br />