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[SELL 7 ST lP,7"L�Lx�,� TLIL""'�,�VFLLJ° LA — (oc s-MI D # 1 1 7J C` <br /> A8084 OLD AUBURN ROAD GIIH CONSTRUCTION L,44---s- R033/�r 'K`� ! CITRUS HEIGHTS, CA 95850 ❑ SERVICES, INC <br /> (916) 723-7779 LIC #608406 JOB <br /> ■w.i,.nm,,t,llx uC #605350 8084 OLD AULURN ROAD CITRUS HEIGHTS CA 95810 <br /> i <br /> CHAIN OF GUSTO Po # <br /> JOB NAME u - LAB <br />' PROJECT MANAGER 1 c—k— O� SAMPLES COLLECTED BY <br /> SAMPLE TYPE <br /> SAMPLE TYPE ANALYSIS <br /> o SAMPLE LOCATION DATE TIME NO CONTAINERS) REQUIRED <br /> ca SOIL AIR WATER <br /> G3 Xf 1, I <br /> pml <br /> v <br /> 25e- <br /> 1 x _� <br /> PRINT R SIGNATURE <br /> RECEIVED BY DATE/'TIME <br /> REL 1S R ZC=D BY DATE/'LIME _ <br /> ' RELINQUISHED BYRECEIVE B V��' DATE/TIME <br /> RECEIVED FOR LABORATORY BY DATEa/PIME <br /> METHOD OF SHIPMENT <br /> DISPOSITION <br /> STORAGE ❑ REFRIGERATOR ❑ FREEZER <br /> RN AROUND TIME <br /> SECURED <br /> ❑ 24 HOURS ❑ 3 DAYS ❑ 1 WEEK ti WEEKS � ❑ <br /> I'ASI,.' HAVE FACFI DATA S Y15 NO <br /> ' NOTE' Pi TA tiIiEET SIGNED BY CHF.A4IST <br />