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name ZTdI6S An equir <br /> L"1��. �JlCcmyY\�ly1�aX r�`b�Mo t , ric . Zk0b —:L\1 - G <br /> Address -7 \ / NIX <br /> Phoned �I <br /> X7 / <br /> 9' S Y� -ry1-Qv^ NI X ��\�e 200 '�1�1 A40 _ ?70D 0a <br /> City,State,Zip Report ention 1 �\ a 0�0 <br /> "1(V��C a1Z7�� .0 hV\\2 1Vl^QtD /)V �cQ��o <br /> Sampled by `U y <br /> Lab Type" w e S�x 1 r1��{ p Number `aoTr <br /> Sample Date Time See key of tia�c; <br /> number sampled sampled below Sample description containers ZagQ Remarks <br /> So U a.�_\ 1 l4�� <br /> gt_5 So +i 1 <br /> g1-�o So '' ✓ <br /> bl-I� 1,0o A� �nrfw V71 v 2 ✓ <br /> 11,10 S o r7a ✓ <br /> S SJ i <br /> SQ '' ✓ <br /> So I ✓ <br /> Signature Print Name Company Date Time <br /> Relinquished by fZO Vf P L�(b_R-p <br /> Received by G <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> I /I., L�u c, <br /> Received by Laboratory <br /> B C ANALYTICAL Note:Samples are discarded 30 days after results are reported unless other arrangerrle is are made. 'KEY: AO—Aqueous NA—Nonaqueous SL—Sludge <br /> El 1255 Powell Street,Emeryville,CA 94608 (415)428-2300 Hazardous samples will be returned to client or disposed of at client's expense GW—Groundwater SO—Soil OT—Other PE—Petroleum <br /> ❑ 801 Western Avenue,Glendale,CA 91201 (818)247-5737 Disposal arrangements: <br /> ❑ 1200 Pacifico Avenue,Anaheim,CA 92805 (714)978-0113 <br />