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"Wood .0.J <br /> CHAIN OF CUSTODY / ANALYSES REQUEST FORM <br /> Project No. Field Logbook No. : Date: zit + Serial No. : <br /> Project Name:�fv� S Project Location: SWT— N° 3294 <br /> Sampler (Signature) : r IT ANALYSES Samplers: <br /> SAMPLE <br /> SAMPLE NO. DATE TIME LAB SAMPLE TA N CON- <br /> STYPEE AQP �Q B 0 REMARKS <br /> All .r <br /> Ad- <br /> Jam . <br /> JrS <br /> 6 <br /> 4 S <br /> -7c- <br /> I<Eport LL i )I Iy <br /> RELINQUISHED BY DAT TIMRECEIVED BY DA E TIME <br /> (Signature) (Signature) I �V ;Z O <br /> RELINQUISHED BY: D TE TIME RECEIVED BY: DATE TIME <br /> (Signature) (Signature) <br /> RELINQUISHED BY: DATE TIME RECEIVED BY: DATE TIME <br /> (Signature) (Signature) <br /> METHOD OF SHIPMENT: .n DATE TIME LAB COMMENTS: <br /> SAMPLE r�_,ZLEVINE•FRICKE LEVINE•FRICKE Analytical Laboratory: <br /> COLLECTOR: '�'` <br /> (check one) 629 Oakland Avenue 4019 Westerly Place, Suite 103 'C <br /> Oakland, CA 94611-4567 Newport Beach, CA 92660 <br /> (415) 652-4500 (714) 955.1390 <br /> Shipping ropy (white) Lab Copy (Green) File Copy (Yellow) Field Copy (Pink) FORM NO, 86/COC/ARF <br />