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Hazardous Waste Management <br />Fingerprint Verification Laboratory <br />Completed by: <br />Dat—: JUN 2 2 2005 s <br />COC# G (� <br />Chain -of -6 1 <br />Send all results to: <br />1 <br />��e ►-� IVi W Ma,►'� <br />Analysis Required <br />Field <br />Contact: IU- Nk1�JGnGv� <br />v <br />Comments <br />�- �� - o- <br />Phone: LI Z 5 L Pager <br />FVL# <br />WDR# <br />Profile Verification <br />_ _ <br />Annual Conditional <br />Annual <br />Verification <br />Site 300 <br />Waste Description <br /># of <br />containers <br />submitted <br />ozugS <br />ON307Tu <br />A <br />,VA <br />IJ U�i GV Tar <br />I <br />K- <br />k <br />cy <br />a 2 v <br />W i43 Ill <br />/� <br />3 d rd w— h) ar1L <br />73 <br />K <br />� <br />S <br />Additional description/comments on the sample: <br />Siqnature <br />Time Date <br />Sam p led b t- \k-,' <br />0--i <br />�- �� - o- <br />Relin uished b : <br />-(J5 <br />Received b : <br />(,a —( ' <br />WGSform 0005 (11/28/00) CONTROLLED FORM <br />NOTE: Do not cross out or erase data. Draw <br />a single line, date, and initial any change. <br />