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State of California-California Environmental Protech n A,, Y Department of Tobc Substances Control <br /> Northern California Region OFFICIAL SAMPLE RECEIPT Southern California Region <br /> --amento Office Glendale Office <br /> I Croydon Way,Suite 3 1011 N.Grandview Avenue <br /> ,amento, CA 95827 Glendale,CA 91201 <br /> (Y16)855-7700 (818)551-2800 <br /> Clovis Office <br /> 1515 Tollhouse Road Cypress Office <br /> Clovis, CA 93611 57%Corporate Avenue <br /> (209)297-3901 Cypress,CA 90630 <br /> (714)484-5300 <br /> Berkeley Office <br /> 700 Heinz Avenue,Suite 200 <br /> Berkeley, CA 94710 <br /> (510)540.2122 <br /> Firm Name Date <br /> Address City Tp Cade <br /> Person Interviewed Position <br /> The items listed below were collected as official samples on this date as authorized by Section 66272.1, California Cale of <br /> Regulations, Title 22. <br /> Quantity Unit Size Sample Description ID Number <br /> 41 <br /> I <br /> Receipt acknowledged,by: <br /> By <br /> Signature Authorized Agent <br /> DTSC 1237 (04/98) <br />