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MWIPF mom <br /> WH <br /> F !/VIr <br /> HF Environmental Consultants, Inc. <br /> Post Office Box 6729 <br /> CHAIN OF CUSTODY RECORD Modesto, CA 95355-6729 <br /> (209) 579-8138 <br /> PROJECT NAME: <br /> D <br /> SAMPLERS (signature) Number ���°, (� <br /> � � fi <br /> )Tilt~ / REMARKS <br /> of <br /> Station Cori- � 4% <br /> Number Date Time Ofd Station Location tainers <br /> 0-3 <br /> 6 Ito <br /> t h�:►na� X <br /> U <br /> .fir. ,�'l.0—]�.S /11/91 / n..•! 1j <br /> l �-� 5 ��z �1Sn X K <br /> oto <br /> >a, <br /> 4-1 <br /> rl IX I to <br /> R �7 ui ed signature): Date 1 Time Red iv by (si r�e�•` Reli i ed by�sgo ltd e): Date / Time R v d �y- Ig a�e): <br /> ,.. , <br /> Company oT enc): / :h Comoaa or �e�icy: o p y or A49'cy: �� i7 r' anj or Agency:, � <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received by (signature): <br /> Company or Agency: Company or Agency:' Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Company or Agency: (signature) <br />