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--.1740, CITY OF EVERETT <br /> ENVIRONMENTAL LABORATORY ANALYSIS REQUEST <br /> /. :/d1::,1, mr <br /> 3200.CEDAR STREET, EVERETT,WA 98201 CHAIN OF CUSTODY <br /> iv ;ate Phone: (425)257-8230 Fax: (425) 257-6033 PROJECT# <br /> // <br /> DATE: <br /> IENT: / ADDgRE�SyS: Cedar <br /> Street <br /> yy� <br /> it..tV o�.. erett !20 "weda StreetGRAM: SAMPLE SITE: <br /> 'ea-1 Propetty <br /> Everett, VA 96201 <br /> PHONE: COLLECTED BY: REQUESTED BY: <br /> Nike &i cit <br /> equested sample report date(If less than 30 days): ANALYSIS REQUESTED <br /> 4'. <br /> RPOSE: ,ARI <br /> IN LAB 0 OUTSIDE LAB <br /> CONTRACT CONTRACT , <br /> SAMPLE LIMS ID# SAMPLE SAMPLE COMP SAMPLE ' <br /> DESCRIPTION: (Lab Use Only) DATE TIME GRAB MATRIX <br /> i: - -- - / - <br /> w <br /> . <br /> .. s s .5'. .,,to . <br /> h . <br /> .4 a <br /> Yr,i. <br /> I <br /> I <br /> III i <br /> •INDICATE:LAB PERFORMING ANALYSIS/#OF CONTAINERS <br /> CHAIN OF CUSTODY <br /> t <br /> DATE TIME <br /> elinquished *Receaved4 d <br /> DATETIME <br /> 'Relinquished. <br /> a - *Received: � ' � ,, <br /> r <br /> elinquished: `Received: <br /> DATE TIME <br /> DATE TIME <br /> elinquished: *Received: <br /> COMMENTS: <br /> Sond copy of Report to',,, Jon SoSondergaardiAs6ociated Earth .encea o Luc* <br /> 911 5th Avenue. Suite, 1 0,, Kirklaod, WA 9 <br /> ecause the City of Everett Environmental Laboratory is a public agency, data, test results, reports and other documents are public <br /> cords and therefore subject to disclosure to third parties upon their request pursuant to RCW Chap.42.17. <br /> F-ARCC(9/06) DATABAR.INC. <br />