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CHAIN OF CUSTODY / ANALYSES REQUEST FORM <br /> Project No, Field Logbook No. : Date: �y Serial No. : <br /> Project Name: Project Location:s N? 4 281 <br /> Sampler (Signature) At4ALYSE Samplers:NO. OF <br /> ' I p <br /> Xol <br /> SAMPLE NO. DATE TIME LAB SAMPLECON_ SAMPLE <br /> NO. TCN — TYPE REMARKS <br /> AIRLo �Jal <br /> 2 ta)� <br /> 1 <br /> 67 W <br /> D � <br /> "L 10 <br /> J <br /> v <br /> 4_ <br /> lot <br /> ,J <br /> -M11 71. 4- <br /> RELINQUISHED BY: ` DAT TIME RECEIVED BYiO <br /> /A�, E TMEt{� <br /> f } <br /> RELINQUISHED BY: <br /> (signature) DATE TIME RECEIVED BY: DATE TIME <br /> (signature) <br /> (Signature) <br /> RELINQUISHED BY: DATE TIME RECEIVED BY: DATE TIME <br /> (Signature) <br /> METHOD OF SHIPMENT: J��� 4 DATE TIME LAB COMMENTS: <br /> i VJ Jq I I <br /> Sample Collector: LEVINE-FRICKE Analytical Labo atory: <br /> 1900 Powell Street, 12th Floor <br /> Emeryville.Ca 94608 ] <br /> (415}652-45500 <br /> Shippino "spy (White) Lab Copy (Green) File Copy (Yellow) _-Eield Copy (Pink) FORM NO. 86/COC/ARF <br />