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1117 Lone Palm Avenue <br /> Suite B <br /> Modesto,CA <br /> A 5 5 U C I A T E S I N C , <br /> Company Name:N-(G ASSOGirn4,-_S rnc. Project Name-s; .A ,dam + t?adZ <br /> Mailing Address: Vk%-4 L.av,�e .amu.. 1I,A. sil,�-te Billing Address (if different): <br /> City: dd.eSk-o State: ems► Zip Code: °!5351 <br /> Telephone: 209_ 5 fig- 2 22 FAX #: Z09 544-z27-s P.O. #: <br /> Report To: %4A, Sampler: QC Data: XLevel D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround ;ErJ0 Working Days U 3 Working Days ❑ 2 - e Hours ❑ Drinking Water Analyses Requested <br /> Time: ❑ 7 Working Days ❑2 Working Days ❑Waste Water <br /> ❑ 5 Working Days ❑24 Hours ❑Other <br /> Client Date/Time Matrix # of Cont. <br /> Sample I.D. Sampled Dosc_ Cont. Type Sample # <br /> Comments <br /> 1. <br /> LJ C`�l2Zti3 j den( t� <br /> 2. <br /> 3. Q <br /> 4. 4 Z o <br /> 5. <br /> 6. 1 A'40 Z ✓ <br /> 7. V1?,0® 2— <br /> E3.B. <br /> 9. <br /> 10. <br /> Relinquished By: A A,4, Date:] yY a_ Time: 14 5o Received Date: /�Y a Time: <br /> Relinquished By: Date: Time: Received By: Date: Time: <br /> Relinquished By: Date: Time: Received By Lab: Date: Time: <br /> Were Samples Received in Good Condition? C3Yes ❑ No Samples on Ice? Yes 0 No Method of Shipment v ' 'qJyl_ Page I of <br />