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SAMPLE SITING PLAN <br /> INFORMATION REQUIRED <br /> 1. Sk�Lt �y 1 � �15� L/ZvirN lNQ �£YT ✓I� <br /> NAF_ OF SYSTEM <br /> 2. <br /> OWNER(S) <br /> 3 . �3S 1Sv ( Ob /dav �� IULG�i a Jvri <br /> NO. OF RESIDENCES A4 - GE NO. Or PERSONS SaRVED PER MONTH <br /> 4 . F GZ L <br /> NAME OF CERTIFIED LABORATORY <br /> 5. <br /> NAME (S) OF SAPYL--? (S) _= NET LABORATORY PERSONNEL <br /> 6 .NAM S AND PHONE NUMBER(S) OF PERSONS LABORATORY ARE TO CONTACT <br /> FOLLOWING ANY POSITIVL' SAMPLE <br /> A. <br /> Set`1 T tu�i DAY R3/- 61bI u73 e376 <br /> �� CONT <br /> ACCT ?1 <br /> NIGHT <br /> B. LW zacAv DAY <br /> CONTACT =2 <br /> NIGHT <br /> 7 .ADDRESSES OR LOCATIONS OF ROUTINE AND REPEAT SAMPLE SI'Z'ES <br /> me» IY) L ii <br /> ROUTINED-N#1 _ <br /> ISi�RPEAT #1Sa y" � Q.bvfRC <br /> D1 . fi -e -0388 <br /> REPEAT 428 <br /> _ <br /> 0 <br /> I REPEAT #3 _ <br /> REPEAT #4 �/n E'?a o L �`eqjmarks <br /> Seg Remarks <br /> ROUTINE 32 <br /> REPEAT #1 <br /> REPEAT #2 _ -- Y <br /> ( �r li ('► REPEAT #3 <br /> and described hereon but <br /> REPEAT #4 0. ir._.:: o <br /> 8 .SUBMITTED BY:. <br /> or CiBVIHi1C:1 G c_;! ` emEniS (JA State IBWs Of <br /> ..,., ::,.,,,.J. <br />