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�TICALHE ISTS <br /> CHAW0F CUSTODY <br /> DATE: <br /> CLIENT: S�ZV\ HT n 7 innn <br /> y <br /> 5� <br /> ADDRESS: VTpc <br /> Q 1 :� <br /> PHONE NUMBER:w 3 Iq O / PERMIT �HEALTH <br /> /SERVICES <br /> ,d' L <br /> PROJECT NV`E: yZ��� � Uy �� Sr,J� �- W 1 LSdn Vv VI <br /> PROJECYMANAGER: Iv� ��A Z <br /> SA " ERS: I, Y�-17 Oct ('�Ll <br /> eq(e 2 <br /> y✓�c,rwc�Q <br /> ample Location Date Time Number ofsts Date <br /> Number Descri tion Sampled Sampled Containers Re fired Needed <br /> ' <br /> C1'll�Ci lot <br /> 6TX <br /> sorE�T�N- 6, <br /> 3 szP • 3 �[ 17 ao f l�o 3Ek <br /> L "1 11/46 11, 10 2 erxrc zip <br /> JvV4r=,TPN- <br /> t w 5-c. Lr <br /> •.�` (P cep. 33 c P-rHc+ s <br /> 2 �tcrt -rpN- <br /> c� 1 <br /> c C M lG L EiC <br /> 17q <br /> Relinquished By: Received By: Date Time <br /> YIK12 0 (03- <br /> ° <br /> By +� <br /> Relinquished �y Rec ived : Date Time <br /> Relinquished By: Received Sy: Date Tire <br /> MAI' OFF7CE- 853 CORPORATIONCORPORATIONATION STREET- F.O.BOA 271 BRA.'�CN C1FF10E- 2- <br /> ;(►,:STAGECOACH ROAD <br /> &LABORATORY SAN'TA PAULA,CAUFOR.ti1A 93060-M72 &LABORATORY STOCKTON,CALIFORNIA 93205 <br /> (60;)525-3824-•(826)659 0910 (2011)942-0161 <br /> FAX (K6)5254172 FAX (2 05)94'-0;23 <br />