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CITY OF EVERETT ANALYSIS REQUEST <br /> ;c' ENVIRONMENTAL LABORATORY <br /> i1� 3200 CEDAR STREET, EVERETT,WA 98201 CHAIN OF CUSTODY <br /> �. � Phone: (425) 257-8230 Fax: (425) 257-6033 PROJECT# <br /> J I" <br /> DATE: ,u:__ �f" :.r(. <br /> ENT: ADDRESS: <br /> City of Everett 3200 Cedar t e t <br /> OGRAM: SAMPLE SITE: <br /> -eal a r . ;= t Allez- stick Property Lverett. WA S84.0I <br /> PHONE: COLLECTED BY: REQUESTED BY: <br /> ;AA i -r�</i :. v I Mike .iac 10 <br /> ANALYSIS REQUESTED <br /> equested sample report date(If less than 30 days): <br /> PURPOSE: :,/ <br /> ❑ IN LAB 0`OUTSIDE LAB 1` <br /> CONTRACT CONTRACT ,' e. <br /> SAMPLE : <br /> LIMS ID#' - SAMPLE SAMPLE COMP SAMPLE f ; <br /> DESCRIPTION: (Lab Use Only) DATE TIME GRAB MATRIX A af'""`?, . <br /> . <br /> "`s <br /> it 47('(_ ._.�. ir, :. <br /> - is .✓ !. <br /> 1 <br /> •INDICATE:LAB PERFORMING ANALYSIS/#OF CONTAINERS <br /> HAIN OF CUSTODY <br /> r ✓t t'• DATE TIME <br /> •elinquished: I ( "Received ' 1 y <br /> DATE TIME F <br /> `Relinquished: "Received: . <br /> DATE TIME <br /> 'elinquished: "Received: <br /> DATE TIME <br /> *Relinquished: *Received: <br /> I <br /> COMMENTS: <br /> copy ut o tt t Jort Sod5.+r aardiP e ciate Earth Sc iencev, i cs <br /> II8. A... 1`. 9 La{&z'r E <br /> �: .��: ����::���� 8 . �� I���# ;.ice <���: m � ,�f:�.�., <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 />