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LHt3UNHTUR ... �A_ . 03/18!41 10117 P.02 <br /> 9 <br /> r• ,` <br /> OF CUSTODY <br /> RECORD <br /> AMM>rrW-4L <br /> LAWWATOW <br /> PERSONNEL o <br /> SITE INFORMATION <br /> Sampler (Signature) L�V f <br /> Joh Name - <br />' Phare [5 � c# ;r <br /> Job Number Q .�. Q <br /> ,F <br /> Sample Location � rA <br /> Field Crew Supervisor __- <br /> f .. <br /> Field Company ;3 i <br /> Project Geologist/Engineer Hip�. ( °�a, P.D. Number <br /> Rel1�hed by (Signatur ) o Received by (Signature). Date Time <br /> II <br /> Relinquished by (Signature) Received by ( gnature) {� Date Time <br /> I <br /> Analysis laboratory should complete "sample Gond. upon rece�; pt" section below, <br /> sign. and return copy to Shipper ri <br /> ) <br /> Sample Sample No. of Site Date Analysis $ample Cond. - <br /> ,Nu�rtJi�ze�r TYoe Cont. Identification Sample s' Ra'ue ted Uan- Receipt <br />` r <br /> j <br /> 1 ! V I i, <br /> 4 <br /> P <br />€ Remark$! <br /> 3 <br /> AW, AtMENnd ` ii p <br /> Cit 1 <br />