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IS <br /> ZARDOUS MATERIALS LABORATY <br /> LABORATORYT <br /> TO: eL # 041 <br /> name person reuesta g ana ysts 3 <br /> COPY TO <br /> COLLECTOR IS SAMPLE C�� ro — C DATE REPORTEa-= <br /> LOCATION OF SAMPLE COLLECTION: DATE COLLECTED �} <br /> NAME aMyy Z <br /> ADDRESS <br /> numbe street city state zip <br /> ANALYTICAL PROCEDURES USED: <br /> REFERENCE: <br /> ANALYSIS RESULTS : iF 10 01 <br /> C-C3c� I _ <br /> gni J" <br /> 1 tJ jpp)py) <br /> a <br /> t <br /> Col fornia Department <br /> ®i Hecslth Serv'sces <br /> � 4 ;(o <br /> ANALYSTS' SIGNATURES: SIGNATURE OF SUPERVISING CHEMIST <br /> date ate <br /> 2. m <br /> date <br /> California Departmp- ` of Health Services - Hazardous Materials Laboratory <br />