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jdMIrEOTEST <br /> h 3960 E GUman Street GEOTEST ,,y� <br /> Long Beach,90815 PROJECT NO 053 0v <br /> mw Telephone (310)498-9515 (800)624-5744 CHAIN-OF-CUSTODY RECORD <br /> Fax (310)597-0786 DATE PAGE _/_ OF <br /> PROJECT NAME C., 4 Y METHODS SPECIAL HANDLING <br /> ADDRESS S On Lu w <br /> Co <br /> SAMPLER'S SIGNATURE z z <br /> PRINTED NAME_ c } n h 0 w <br /> co <br /> CLIENT PROJECT NO w x Z 0 <br /> PROJECT MANAGER a, x <br /> _ x w CO a <br /> ti <br /> (v ¢ o o <br /> SAMPLE NO DATE TIME LOCATION k' F- m v U # <br /> r. 2 736 i/o- <br /> RELINQUISHED BY DATERELINQUISHED BY DATE RELINQUISHED BY DATE SAMPLE CONDITIONS <br /> RECEIVED ON ICE YES/NO <br /> A URE 51GNATURE SIGNATURE CHAIN OF CUSTODY SEAL YES/NO <br /> k6e I I 13 0-t A, 1/1, IV, - <br /> P INTEME TIME PRINTEDNAME TIME PRINTED NAME TIME <br /> PROJECT COMMENTS <br /> COMPANY COMPANY COMPANY <br /> ECEI'ED B DATE RECEIVED BY DATE RECEIVED BY(LAB) DATE <br /> Al <br /> I <br /> RE SIGNATURE SIGNATURE <br /> D NA E TIME PRINTED NAME TIME PRINTED NAME TIME 1 <br /> 1(r- <br /> COMPANY <br /> 1� j COMPANY COMPANY <br />