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STL San Francis-Wham of Custody ��017-0970 <br /> TL1220 Quarry Lane • Pleasanton CA 94566-4756 Reference# �2� <br /> ° Phone (925) 484-1919 • Fax (925) 4$41096 <br /> Small lnfoCED-chromalab com Date .ZO Page of <br /> RequestReport o <br /> Analysis <br /> Attn C ,✓�c�/u S�S„Ei�lP U- <br /> -- X= 00 <br /> L, N o <br /> Company '�j� p�� �'�4c,�icor/%47,g.el, m C7 m 'w❑ p E in n o U C ❑ <br /> Address / �] f ❑ V U O m p ❑ 7 <br /> y� ��� ❑ m 'gyp c7� m " m o 0(0 ❑ u E QH ❑❑ <br /> Phone .��tib `°fi�[a/Email _�x �_ ❑ ❑o �`0 r t�U3 CO N a� m w � L E ❑❑ o p" N <br /> °Y.Z6�I.Z3 �~ o o❑ N❑ �0 ❑❑ N ti J U9 UZ <br /> E3i11 To Sample y �m m E m p o�' u (❑ 0) W W co `a � F W� c 0 - <br /> 11�F�4) ❑❑ oC] W� a roa Mo wCa �� ❑❑ ❑ m� w mr cj Um` o <br /> Q q c 2 a q�m N i� a1 L` -J M y v ❑❑ U <br /> C � a 3 —nw wO ap m Om mmn' [7� W a � [] W4 X� a)irn o <br /> lain !• St°6!t Phone A S .4, E ua m X U En Lu _v m� m 0. °a c� a N N �^`ED N, SIU— s a U)l'- <br /> 1F c a <br /> Sample � ' is ar s ❑ aa � np oarix erv. ¢ z <br /> g o W A <br /> Pro <br /> _ Info. Sample Receipt 1) elr i ed by 2)Relinquished by 3)Relinquished by <br /> Project Name #of Containers �S 'ILJS <br /> Signature ime Signature Time Signature <br /> Time <br /> Project# Head Space �L <br /> PO# Temp Printed Name Date Printed Name Date Printed Name Date <br /> (p° <br /> Credit Gard# Conforms to record Company Company Company <br /> T 6 1)Received by 2)Received by 3)ftceived by <br /> A Day 72h 48h 24h Other <br /> T <br /> Report ❑Routine ❑Level 3 ❑Level ❑EDD ❑State Tank Fund EDF Signature Time Signature Time Signature Time <br /> SnPcIRi 4nstructions 1 Comments ❑Globai ID <br /> Printed Name Date Printed Name Date Printed Name Date <br /> S-L-- <br /> Company Company Company <br /> Rev 07102 <br />