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SAFETY SPECIALISTA I-- P.O. Box 4420, Santa Clara, CA 95054 <br /> T^'Fp1 Se'- Telephone(408)988.1-111 <br /> • Contractor's License No. 460905 <br /> CHROMALAB FILE #G392082 <br /> ORDER # <br /> �, nK Fxpo+.,CHAiiiv CUSTODY REC-ORD <br /> Collector: Sam led: Time. <br /> _ — <br /> Location of a p Ing: <br /> r <br /> Project Number: '.5Qlaa/ -61 -Sgrvey Number: <br /> Sarnple Type: <br /> 7'- <br /> Container Type and Condition 49SS <br /> Contract Laboratory Record/Name: CA keom"— -ed- <br /> Sample ID / Field Information <br /> � 5 � � _ r <br /> eai. vc . - ... <br /> 8 S - 3 S�la�-�t (�_�- -So,,.[ a+•� /460.x.. > .c:?�7u-u� <br /> n <br /> Analysis Requested: �'PH 17lC�Aa.Q hxzeX. 3 <br /> y ' <br /> Results Needed By: <br /> Travel Blank: ❑ YesNo Travel Blank to be Analyzed Separately: [3Yes No <br /> Duplicate Samples: ❑ Yes . No Duplicates to be Analyzed Separately: .❑Yes No <br /> Field Blank: ❑ Yes No Field Blank to be Analyzed Separately: ❑ Yes No <br /> Background Soil Sample: ❑ Yes No Background Soil Sample to be Analyzed Separately: ❑ Yes No <br /> ChaiAof N s dy: <br /> a&/9z <br /> Field Persorinfil - Date - <br /> 2. unR/92— <br /> 3. Coe � °`� 17a4 <br /> Lab Date <br />