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O <br /> i <br /> Light, Air and SpaGe Construction Chain of Custody <br /> Mailing address P O Box 3634?, San ,fuse, uA 9 ;58 <br /> Office address 9 707 Little Orchard Street, Sults A, San Jass, CA 95125 Date 5/tp lar.- <br /> 408-979-0661 office 408-640-2899 Dave Guthndge cell phone <br /> 408-979-0621 fax Contractor's License Number 445403 Prot No 000 W <br /> N <br /> Page 2 of 3 <br /> Project name � ,� E <br /> Relinquished by Received by. <br /> - <br /> a3 Print name. Date received �' /4 -a <br /> ' �^ G {�� 1 Print name. <br /> 3L�erty <br /> Company name awr rrM_ A � Lab name �tK't - Time received, <br /> rel v <br /> w <br /> c Special Instructions <br /> o <br /> U V Recreved in good condition <br /> CL r 'y Yes '� No <br /> V U M <br /> 13L tr <br /> H = , Total I of Samples <br /> E K O <br /> Sample I D Date Time Matrix z � <br /> LL Comment` <br /> 4 tiLa- t /w�.► �j i Ib ,a ✓ i-C r,.m�.e.t Z►1 <br /> Q <br /> .sr 1k fry ✓ � Car— qc <br /> .0 r3(a Sfa —tij 7" f/r r v atcl? <br /> Ot k7 J Y�.�rs, �dla� <br /> s2K <br /> J <br /> CL <br /> r` <br /> N <br /> 44M <br /> 0 <br /> 0 <br /> r <br /> r <br />