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Hazardous Materials Laboratory Section <br /> SAVE SAMPLE(S) REQUEST FORM <br /> HMLN X2. 9 tc <br /> Save samples until . . . . . . . . . . . <br /> (date), <br /> Discard samples . . . <br /> date <br /> .... .... .... .... .. . <br /> Reason for saving samplesi <br /> . . . . . <br /> Phone H) Signature '.of Collector : (Date) <br /> If HMLS does not receive a completed ."Save' Samples) Request", the samples <br /> will be disposed 60 days from the date of the final analytical report. <br /> Return completed form to: California Department of Health Services <br /> Hazardous Materials Laboratory Section (HMLS) <br /> 2151 Berkeley Way <br /> Room 235 <br /> Berkeley, CA 94704 <br /> 3/85 <br /> oo6 <br />