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CHAIN OF CUSTODY / ANALYSES REQUEST FORM ` <br /> � 3 <br /> Project No. : 1/i'3�'' Field Logbook No. : Date: 2 Serial No. : q0 <br /> Project Name: <br /> Project Loca <br /> �� v tion N° 4280 <br /> Sampler (Signature) ��: <br /> w4,cq ANALYSES d T rA Sampl s: <br /> S A M P L Cr �J <br /> u <br /> SAMPLE NO. DATE TIME LAB SAMPLE NO. <br /> OF SAMPLECON <br /> N0. TAINERS TYPE �' �`' �1 REMARKS <br /> k ► N 4 <br /> 2 I <br /> 16ZZv <br /> r� dyl <br /> X 4n <br /> } <br /> } <br /> ' rN f <br /> } t-.2_ <br /> ins lei C I <br /> V� <br /> RELINQUISHED BY; ` DATE TIME RECEIVED BY; DTE TI E <br /> T---;(Signature) J Z q (Signature) <br /> RELINQUISHED 8 DATE TIME RECEIVED BY: DATE TIME <br /> (Signature) (Signature) <br /> RELINQUISHED BY: DATE TIME RECEIVED BY: <br /> (Signature) (Signature) DATE TIME <br /> METHOD OF SHIPMENT; DATE TIME LAB COMMENTS: <br /> Sample Collector: LEVINE-FRICKE Analytical Laboratory: <br /> 1900 Rowell Street, 12th Floor f <br /> Emeryville,Co 94608 q <br /> (415)652-4500 <br /> Shipping ''npy (White) Lab Copy (Green) File Copy (Yellow) _,.Field Copy (Pink) FORM No. 86/COC/ARF <br />