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f. Date and time: <br />Name: <br />Affiliation: <br />Telephone number: <br />Address: <br />Information provided: <br />Instructions received: <br />13. Samples taken? Yes/No <br />a. By whom: <br />Time: <br />Date: <br />Number of samples: <br />Specify sample type: water/soil <br />Where were samples taken?: (Describe location and specify distances.) <br />