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` <br /> UiET21~NCINRERINC AND CONSTRUCTION, INC. X i LQ-1OCoCHAIN OF CUSTODY / <br /> Ti-imsmit,results to office checked belovvr ,REQUEST FOR ANALYSIS <br /> M <br /> 33233 South Koster Road,Tracy, CA 95304 RECORD <br /> Voioa(209)832-2910 Fax: (209)833-1288 <br /> O 1120 Hollywood Ave:No, 3, Oakland,CA 94602 Laboratory; _(�7e-- Z� <br /> Voloe(S10)336.9118 Fax: (510)336-9119 Carrier; <br /> Pmjeot'. C ,. ��Z C ��c �. ) Waybill No, <br /> Project No.,, Projeot Mgr. <br /> Sampling Tea , S s ,o <br /> m <br /> Site Global LD, No, <br /> Analyses Requested Lab,No, <br /> Bnmpie Type Mold 'Wellltood/ •Doplh to We Tlmo �' 9 <br /> Number Pelgt 8wf.Zlev, (; W/snmple sampled 6mmplod. <br /> U <br /> C <br /> N <br /> N <br /> O <br /> f0 <br /> O <br /> J <br /> 16 <br /> V <br /> T <br /> C <br /> Q <br /> O <br /> N <br /> Priority,, Routine Ck axpedited O 6peafal D <br /> Sample Hazards <br /> Notes: � �f w lZ,..�� � <br /> CIIi3'MY CORD Print Name otn a Date Received Time Received Date RetlTimo Re! wished Signature <br /> originator ::;t <br /> Receiw&RWinquishedby, . ���� 1�'ln(Oi <br /> Received/Rellaquished by: <br /> EL <br /> Reoeivod/Relinquished by; <br /> o <br /> Recelved at Laboratory by; r Roy,0/0 <br /> N ' <br /> N_ <br /> N <br />