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• CITY OF EVERETT
<br /> ANALYSIS REQUEST
<br /> 3200 CE
<br /> Ko_n
<br /> EN DV Al RROsNTMREENETTA,L LAtEBZR41,\ONRAY CHAIN OF CUSTODY
<br /> 98201
<br /> Phone: (425) 257-8230 Fax: (425) 257-6033 PROJECT# -1
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<br /> IIENT: DATE: : '( ''
<br /> ADDRESS:
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<br /> equested sample report date(If less than 30 days;:4'1' : '' ''''''''''''
<br /> ANALYSIS REQUESTED
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<br /> RPOSE:i IN LAB D OUTSIDE LAB
<br /> CONTRACT CONTRACT — " cd i
<br /> SAMPLE LIMS ID# SAMPLE SAMPLE COMP SAMPLE
<br /> DESCRIPTION: (Lab Use Only) DATE TIME GRAB MATRIX
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<br /> •INDICATE:LAB PERFORMING ANALYSIS/#OF CONTAINERS
<br /> CHAIN OF CUSTODY
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<br /> "Relinquished: *Received:
<br /> IIRelinquished: *Received: DATE TIME
<br /> DATE TIME
<br /> elinquished:*t *Received:
<br /> lCOMMENTS:
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<br /> cords
<br /> ause 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 /> E-ARCC(9/06) DATABAR,INC.
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