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6--ow . 1..,.m I■moo 6 Mw Lam.. <br /> 5" <br /> CHAIN OF CUSTODY / ANALYSES REQUEST FORM <br /> Protect No. : l�L8 Field Logbook No. : Date: 7 g17 Serial No. : _- <br /> Project Name;�`�� � � � Project Location: .5dH N° 4274 <br /> A,VbSampler (Signature) ANALYSES Samplers: <br /> P E S Af.NO. <br /> ( LAB SAMPLE CO — SAMPLE 0 <br /> SAMPLE N0. �A l cots- 711 �y REMARKS <br /> 15� ND TAINERS TYPE L/. <br /> I z-1 `t b '7 <br /> — ca <br /> Q <br /> Z � <br /> v IrUlw <br /> Z l <br /> RELINQUISHED BY: DATE TIME RECEIVED BY: DATE TIME <br /> (Signature) (Signature) —d _ 14 cj <br /> RELINQUISHED BY: DATE TIME RECEIVED BY: DATE TIME <br /> (Signature) (Signature) <br /> RELINQUISHED BY: DATE TIME RECEIVED BY: DATE TIME <br /> (Signature) (Signature) <br /> METHOD OF SHIPMENT: ! DATE TIME LAB COMMENTS: <br /> Sample Collector: LEVINE-FRICKE Analytical Laboratory: <br /> 19Wme Powell Street, 12th Floor <br /> Emeryville,Co 94608 <br /> (415)652-4.500 <br /> Snipping Copy (white) Lab Copy (Green) File Copy (Yellow) Field Copy (Pink) FORM NO. 86/COC/ARF <br />