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InKLEINFELDER <br /> PROJECT NO. PROJECT NAME RECEIVING LAB: <br /> �l <br /> v-1 NO. TYPE <br /> L.P.NO. SAMPLER (Si nature u ber) (�- _ 1 <br /> (PO.NO. !T OF OF k t` V <br /> INSTRUCTIONS/REMARKS <br /> CON- CON- <br /> DATE SAMPLE I TAINERS TAINERS <br /> TIME SAMPLE I.D. MATRIX \ C <br /> MM/DL)/YY HH-MM-SS <br /> 6-1 <br /> 21 <br /> . 1 <br /> 5 1 —t L �0, <br /> 6 <br /> I <br /> Ali <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> 17 <br /> 18 <br /> t <br /> 19 <br /> r <br /> 20 <br /> i <br /> Relitfished y:ISignat re) DateMme Rece)�d by:(Signature) Instructions/Remarks: Send Results To: I, <br /> KLEINFELDER <br /> Reiipqush >(Signa re) atelTi e <br /> He "ed ed by�(Signat�re) 2825 EAST MYRTLE STREET <br /> STOCKTON, CA 95205 <br /> (209)948-1345 <br /> 14 <br /> ,Rdtpquisheclby:(Signature) e Receive for Laboratory by:(Signature) Attn: <br /> M-60 White-Sampler Canary-Return Copy To Shipper Pink-Lab Copy <br /> CHAIN OF CUSTODY 3 <br />