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� COL'4pE. <br />i <br />17 <br />Environmental Health <br />Phone: 703 / 777 -0234 <br />Fax: 703 / 771 -5023 <br />Loudoun County Health Department <br />P.O. Box 7000 <br />Leesburg VA 20177 -7000 <br />CERTIFICATION <br />Community & Occupational Health <br />Phone: 703 / 777 -0236 <br />Fax: 703 / 771 -5393 <br />C�5/ LCTM: � r A A Z <br />LOCATION: EL'�f�� _S— T�,�L�`,,c7�� y,�• a0j6 <br />I hereby certify that the water sample(s) for bacteriological analysis for an <br />Occupancy Permit was collected from the above described property and was <br />submitted to an approved laboratory according to the Loudoun County Health <br />Department's instructions. <br />v <br />Date SignatdJe <br />VDHOF HEALTHNT <br />Etu4ec1wW You and Your Envwrxvmw <br />