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F'GL E:tiVIENTAL •� <br /> ANALYTICAL CHEMISTS <br /> CHAIN OF CUSTODY <br /> DATE : <br /> CLIENT: <br /> ADDRESS: �i( C f(. F'Sk. GfJ UdVL gZ-7 1EJviz1 ;5� ( 19 <br /> PHONE NUMBER: 1 <br /> PROJECT NAME : �VI Mt --y lv) 6 C )t-� : 3683(° S JQir f'I wZ� <br /> PROJECT MANAGER: Lln 6,C3SIr <br /> SAMPLERS: Mary U. 6f6C !L <br /> Sample Location Date Time Number of Tests Date <br /> Number Descr. tion Sam led Sam led Containers Re wired Needed b <br /> ✓� l <br /> xr� Fi! 1J!?zI$� j1:3ah, , £Di3 <br /> ..r "Cl b 73/$cl i I'9Uwl (i1X4£,TPfI.6 <br /> a <br /> 3 w£sT f„ c-, rL i 2 za Ige1 <br /> .1� T2 ' �£Kt� I�lzal$� f z•.a� r,,., � e?7� `-r p•6 <br /> 5 �P �altd/gq �:23h• ( Fo'w T <br /> 1�L �1,£ Will' ia�Zu1YK 2:35 fJtka-t -r F!-6 <br /> 1nJ <br /> Re inquished By: Received B <br /> Y� Date Time <br /> Relinquished By: <br /> Received By: Date Time <br /> Relinquished By: Received By: ate ime <br /> 1 A i S '7J, /7�3 <br /> MAN OFFICE- 053 CORPORAnON STREET- P.O. BOX 272 BRANCH OFFI�- <br /> �' LABORATORY SANTA PALfU,CALIFORNIA 930[04272 • LABORATORY 250L 57ACECOACH ROAD <br /> (&05)52&3924 -(&W)&59-%10 STs ,CALIFORNIA 95205 <br /> FAX W5)52"172 (209)942dlal <br /> FAX 0209)912-0123 <br />