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•F. <br /> y <br /> I CHAIN OF CUSTODY RECORD �f s' <br /> t prq Analyses requcW <br /> Client name or PON Y <br /> 4ic��STF�[a1 C�,� cera« �-�6�( <br /> Phone aFW4,AJO-560 BOOM, `mob r <br /> Address � <br /> Repon attention <br /> - C'ry.Siete,Zip _ <br /> 44• 119;V6,91 f{i4Tlft& •J !$S/ fG� p"� ,y'.' a?. , <br /> Lab TYW <br /> Sampled by !v t ?,q lei— Numoer 43 e0°� <br /> me <br /> ale � <br /> Sample Gare Tisee kay Z�y� Remarks <br /> numaer sampled sampled below Sample description .containers pQ <br /> 'To.3 i <br /> 51x6 i <br /> -bqt 7 X <br /> ' company <br /> Trme <br /> Signature , print Name <br /> RahnWishwby <br /> i <br /> FRoconad by . <br /> Rokngtwsbed by '- <br /> i <br /> Received tV , <br /> Rokiwwshod by <br /> Received by Laboratory <br /> s <br /> Note: <br /> Samples are discazaed 30 days atter results are reported L.-w3s other arrangemems are mottle. <br /> ❑1255 Powell Street.Emeryville.CA 94608(415)42&2300 Hamdous samples wdr be roturnw to ckent or aisposed at at d.ar;:.upenso. <br /> ©M South fair DIM Avenue,Pasadena.CA 41105(818)745.7553 . <br /> 'KEY:AO—AAt'aous NA—Naiadwous SC-5tu696 GW—Grauner Ql <br /> dweta—Soik Of— ner PE--Penoieun <br /> Anat'exn,CA 92805 <br /> ' <br />