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Light, Air and Space Construction Chain of Custody <br /> Mailing address: P.O. Box 36303, San Jose, CA 95158 <br /> Office address: 1707 Little Orchard Street, Suite A, San Jose, CA 95125 Date: io h l oEs <br /> 408-979-0661 office 408-640-2899 Dave Guthridge cell phone <br /> 408-979-0621 fax Contractor's License Number 445403 Proj. No. 2n c,to <br /> Page 5 of—_ <br /> Project name: <br /> Relinquished by: Received by: 5 rLA4(5 ( ! Date received: _/&--�` -64r <br /> Print name: .fir Print name: m <br /> Company name: Lta 4S Lab name: Uem U Time received: <br /> Special Instructions tilt/ Recieved in good condition <br /> r <br /> nm tU N W Yes No <br /> E <br /> M <br /> o <br /> `o Total#of Samples g <br /> m o w � - <br /> Q R A <br /> (] Sample I.D. Date Time Matrix 2' = �` Comments - <br /> -`V�� - _ 2•• C io(,(o�'j i�>?.o nIL ( I1 u ci <br /> —l�`30 obty-to -�zz• x t"f�/b i33v v�� I <br /> �(73�� brlc' C1' r2,• [o�=(o j3>td D< rO <br /> �-3 06i& `rz-tz,. <br /> -:033A -2t/" I"(�/o9 l3ZS- � t- t� !d ✓ - - - '� _- - <br /> -O _zut /o/14b t335 oc, t leFF <br /> lswl <br /> I <br /> Re1�wr,,6W--A <br />