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COMPUCHEM Chain of Custody Record CW ID: 3 <br /> LABORATORIES 4F <br /> Date 7 fi' 3 Page Of . <br /> WESTERN DIVISION <br /> PROJECT NAME /L?G, GC GC/MS ° INORGANICS OTHER , REMARKS <br /> PROJECT NO.2L/- 200 5 ^ o / <br /> PROJECT CONTACT: o Y o �\k< <br /> SAMPLERS (SI AT E 7;c:�:, <br /> CD o i v <br /> �/ N Cf) N OD U M ` W <br /> cc <br /> "SAMPLERS on <br /> m 00 r; y <br /> PRINTED NAME U N CV C'? `l z & S <br /> W tD U) N U �1 v <br /> SAMPLE NO. DATE TIME LOCATION <br /> k un�.r s <br /> x un ✓rt <br /> 6Y-6--31 /ys ✓rsrS. <br /> 0 <br /> :3L ! 2�� <br /> 6 6"3 lZ3" <br /> 6 ' /L s <br /> 6 3s LSL <br /> 6'16-36 /?�r �k X k uh <br /> S uh ' ✓� rr s <br /> �yG11437 <br /> 3,t;' <br /> l3YS <br /> 6 y635 /3SS <br /> (, o ,//0 X <br /> ( AMPLES REC D IN 13001 C NDITIO <br /> TOTAL NUMBER <br /> RELINQUISHED BY DA E RECEIVED BY DATE RELINQUISHED BY DATE RECEIVED BY DATE OF CONTAINERS <br /> - <br /> Signa 5� Signature Signature igna u METHOD OF SHIPMENT <br /> g/��(if•� "[— Y TIME TIME Printed Name TIME - <br /> Printed Name <br /> TIME printed Name ted Name <br /> trs-� SPECIAL SHIPMENT HANDLING <br /> Company fi Company Company Company OR STORAGE REQUIREMENTS <br /> RELINQUISHED BY DATE RECEIVED 8Y DATE RELINQUISHED BY DATE R C'D BY (�A RATORY) DATE A -r. , .//e�61,• -7e- <br /> Si n Signature <br /> Signature Signature g n,c., <br /> _ TIME ="�'- � th TIME 7 <br /> -- TIME prince ne TI Printed Name Printed Name M�� 4'S Jo its c�C <br /> Printed Name /I I/� W. cfa <br /> Company- - Company Company Company <br />