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CHAIN OF CUSTODY / ANALYSES REQUEST FORM 5 <br /> Project No. : Field Logbook No. : Datt Serial No. : <br /> Gr✓ N <br /> Project Location: a 9 4283 <br /> Project Name: <br /> Sampler (Signature) , ANALYSES Samplers: <br /> 5 P E S L <br /> LAB SAMPLE NO OF SAMPLE QQ QQ �11 �Dti �J� <br /> SAMPLE NO. DATE TIME NO. CON— TYPE �P , REMARKS <br /> TA NERS <br /> 1 74f- t( v <br /> IZ 5 v Y <br /> 1+40 c <br /> (� <br /> L <br /> 4 <br /> LL <br /> n' And <br /> 4L _751 <br /> RELINQUISHED BY: DATE TIME RECEIVED B DATE TIME <br /> (Signature) i ZyC ( (Signature ( n/ ! —) <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: B DATE TIME LAB COMMENTS: <br /> r <br /> Sample Collector: LEVINE-FRICKE Analytical Laboratory: <br /> 1900 Powell Street, 121h Floor 7 <br /> Emeryville.Ca 94608 cr <br /> (415)652-4500 <br /> Shipping C (White) Lab Copy (Creen) file Copy (Yellow) d Copy (Pink) FORM Nf S/COC/opF <br />