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mm MMMMM T <br /> f Og ( DOG -3 <br /> I <br /> Light, Air and Space Construction Chain of Custody <br /> Mailing address: P.O. Box 36303, San Jose, CA 95158 Date: talz(�Ss <br /> Office address: 1707 Little Orchard Street, Suite A, San Jose, CA 95125 <br /> 408-979-0661 office 408-640-2899 Dave Guthridge cell phone Proj. No. Dh i(o <br /> 408-979-0621 fax Contractor's License Number 445403 <br /> Page 2 of 7 <br /> Project name: 's- la �— .. <br /> Relinquished by: Received by: Date received: <br /> Print name: Print name: ( z <br /> Company name: /,4.4�2 Lab name: wv * Time received: _ L� <br /> a <br /> Special Instructions b v Recieved in good condition <br /> 0 <br /> m mN N Yes No <br /> a E m - <br /> N ~ Q <br /> Total#of Samples <br /> J R <br /> SE a` T v <br /> Sample I.D. Date Time Matrix z' a 1 x Comments <br /> r <br /> —010 /tit r e /o'_ <br /> b(O ?d u� 3 c /3`/5,5 `01?1°15 sow. l 10 <br /> �K) <br /> Z�. m ✓ <br /> i R�Iif,c�o6�,�Q 1a.�x ��6'-D �ecG�uc� b�k <br />