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CITY OF EVERETT <br /> ENVIRONMENTAL LABORATORY ANALYSIS REQUEST <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> CHAIN OF CUSTODY <br /> I►^� Phone: (425) 257-8230 Fax: (425) 257-6033 PROJECT# <br /> DATE: „ ' '''r .1 <br /> ENT: ADDRESS: <br /> (City of Everett tt 3200 Cedar Street <br /> 'GRAM: SAMPLE SITE: <br /> 1. Property Allen—Buick Property Everett, WA. 98201 <br /> PHONE:iCOLLECTED BY: REQUESTED BY: <br /> tii S r . !' Hilo.: Pa';la `1Oa <br /> equested sample report date(If less than 30 days): ANALYSIS REQUESTED <br /> PURPOSE: tad <br /> t <br /> 3 OUTSIDE LAB IN LAB <br /> CONTRACT CONTRACT aka <br /> SAMPLE LIMS ID# SAMPLE SAMPLE COMP SAMPLE { y <br /> DESCRIPTION: (Lab Use Only) DATE TIME GRAB MATRIX <br /> yry <br /> J i <br /> t r `k. <br /> 1 <br /> - - i.-- _ 1 <br /> 7-3 t:,"2 s....,,, 4,7, ,,,/,,,,,,4:,....1 ,,i.:5"v <br /> '# el? <br /> . <br /> •INDICATE:LAB PERFORMING ANALYSIS/#OF CONTAINERS <br /> HAIN OF CUSTODY <br /> / r 1 p DATE TIME <br /> relinquished x ,II-4— i *Received f Y f f <br /> DATE TIME <br /> *Relinquished: *Received: f. \ , `k; \ <br /> DATE TIME <br /> relinquished: *Received: <br /> DATE TIME <br /> s*Relinquished: *Received: <br /> III <br /> COMMENTS:4Wiad copy ofreport to Jon S Dn e Ta k 4I l soc . edI Earth Sciences, Inc. <br /> ill 5th Avunue, Suite Kirkland,1s , WA 98033 <br /> • <br /> ecause the City of Everett Environmental Laboratory is a public agency, data, test results, reports and other documents are public <br /> ords and therefore subject to disclosure to third parties upon their request pursuant to RCW Chap.42.17. <br /> E-ARCC(9/06) DATABAR,INC. <br />