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ATRWORK <br /> CHAIN- OF-CUSTODY RECORD AND ANALYSIS REQUEST, . <br /> PROJl N0. PROJECT NAME A11909'eRA ANALYSIS TYPE REQUESTED <br /> 771E54�52VIC,A�y, V70/i <br /> NO. <br /> SAMPLERS•( ignature) OF <br /> CON- `�, Tp 17w <br /> -;. cc TAINERS <br /> LD. DATE TIME oIr <br /> 4 STATION BLOCATION REMARKS <br /> U U <br /> 55 w /4-4 lou C/ sE2vicE 5TtIn01V 77Wk- <br /> ¢ sz re a <br /> DoE (o q /441) v v v ✓ v ✓ <br /> rFrr� 16FAX <br /> �r <br /> UL <br /> s <br />' 3 <br /> S <br /> a3 -3So <br /> ,. <br /> Relinquished by:by: Date Time Received by: 7• ; Relinquished by Date Time Received bj <br /> '00 0 <br /> Relinquished by: Date Time Received by Relinquished by: Date Time Receive8-4 <br /> m <br /> q Ln <br /> / D ®® <br /> Relinquished by Data Time Re ived by aboratory: Da`e TimeFRIRKS(Shipping Related): C� �9 5AA 'c/ Ca& ,"rnf6c/ <br /> � <br /> 1710 MAIN STREET e ESCALON.CA 95320 • (209)838-3507 <br />