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12-12-1996 d:d9PM FROM P. 3 <br /> Page 2 / <br /> Perscn(s) Taking, sample(5) : <br /> Sample Paint (be saeeific) : _� <br /> Arrival Time: OQSO De?ar-ire Time: D 8S3 <br /> PS at Lndustrj: — <br /> PH Me=cd IIsid...; <br /> Name of Ferson(s) Contacted. --10---L <br /> Principal Poi*:ts of Any Significant Ccnversaticn: a--. <br /> Re=evant seecificz Relat:,nc Samcie Ta_'+;zg: <br /> Unusual Cbsa--Tations or Incidenrs: <br /> T'3e/L'urztian of Observation <br /> /mmc_dent: <br /> Persons) Cantzcyza Recarrittc Dbsa_7aticn/_.c:cezt: <br /> Princinal ?a rots of Any Cenve_a.c'_cn cancw^jZc T,-;- <br /> e_nt.: <br /> Ac�icn Taken or Necessarv: <br /> Signed: Title* <br /> Print Name: Date: Az -S-9G <br />