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North State Environmental Analytical Laboratory Chain of Custody/Request for Analysis <br /> Phone: (415) 588-9652 Fax: (415) 588-1950 Lab Job No.: Page -,/ of/ <br /> Client: �� L• _ Report to: 12, �c'�,.a7l�r _ Phone: -7,ty y�; Turnaround Time <br /> _� — t� <br /> Mailing Address: Billing to: Fax: — <br /> PON/Billing Reference: Dale: /iy <br /> ------------------ _. Sampler: � ./-1 • �7..� <br /> Project/ Site Address: Analysis n <br /> ✓� L ��,L.ri Si/��`L y✓moi) <br /> i <br /> -- �� - — � -- ------_Requested �`��. � �i n J • <br /> Sample ID Sample Container Pres. Sampling a•) Comments/Hazards <br /> Type No. /Type Date/Time �� <br /> � <br /> 0 <br /> � 11 <br /> co <br /> 5w, b _ -- — <br /> Relinquished by: Dale: i �;cY Time: ;c 0 Received by: � , � fee Lab Continents <br /> kRelinquished by: Date: Time: Received by:elinquished by.- Date: Tinu;: Received by: <br />