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�CYf�� �,�Y� d`�E� J�S�' <br />�'�`i�1�TV ��"C�ISd'���' <br />SYSTElO�I NAME: <br />SYSTEIVI ID #: °° <br />, <br />Sample Collected By: <br />Dav Phone: f �0�/ Evening Phone: <br />Sample Sample P/�4 'I'/C F/C DW� <br />Date Time �c <br />� I � f) "� <br />� ��7 f I'�� ,i <br />� <br />CI'TY OF EVERETT <br />ENVIRONIVIENTAL LABORATORY <br />3200 CEDAR STREET: EVERETT WA 98201 <br />Phone: (425)257-8230 Fax: (425)257-8228 <br />t <br />� <br />, <br />' ReportBilling Address: <br />System Owner/1VIGR: ��-�� /� �� �� �� � � <br />/1 � <br />CounYy l�tame: <br />Ct2 C12 Source # Repeat RepeAt Repeat <br />Total Free S 0.[ ] I Sample I.ab Coll. Date <br />�'�I � <br />� <br />�� <br />� � � � � � � � � <br />, <br />�� <br />� *Relinquished: Date: `' � <br />*Because the City of Everett Environmental Laborat`o�y is a public agency,�� <br />1, disclosure fo third parties upon their reqc�est pursuanP to PZCW Chap. 42.17. <br />Project # �.,,,; , � � <br />Sample ID <br />ab:Use Onl <br />J�' Time: � ��.�� � Received: <br />� <br />test results, reports and oP/cer docessnengs a�e pu6lic records <br />DOH IT� # <br />ab Use Onl� <br />ta <br />