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500 Giuseppe Court,Suite 9 <br /> Lra 'W� Roseville,Ca. 95678 CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br /> Environmental Labs (916)773-3664 <br /> Project Manager: Phone#: <br /> ANALYSIS REQUEST TAT C6tr-n x9D• <br /> W.E.T.(✓) <br /> C/o1mpany/Addres1s1: FAX #: <br /> CA av`1�I �l / rilr �L V TOTAL(✓) 3 <br /> Project Number: P.O.#: Project Name: CP r o <br /> o <br /> co co a w o 'c a) o 't N <br /> a <br /> Project Location: Sampler Signature: i'n , (D " w w <br /> 2 O to NY E C4 U) 0L <br /> U0 Lr) CU <br /> a _ <br /> .N O ca <br /> N O_ O (b N _ v (Y tr <br /> m U o W <br /> Container Method C7 "' o °� a s O o N z U cwn <br /> Sampling Matrix No a m 0 o N o w v T > p p <br /> Sample Preserved co m CO _ c7 0 E o 0 o N N J o ^' m W � <br /> N = OD ap ap \N T 90 m U Y n O N W Q <br /> LU <br /> v o a o 0 — c� .n m m v Ln v tl V7 <br /> > W H H to to O O 0 0 O O N N <br /> ID DATE TIME w J , a M w W X m m O m = co cD co cn cD co Cal U = w Z <br /> O -J a v Oz v 0 a 0 cL a. o o a s as a- a a- a w Q a w - X FQ- <br /> > (n � J 2 2 — Z V1 CO CD F- F- F- H W W W W W W W O W U W J U W (n <br /> L - I <br /> �1 -3 PZP ' <br /> Relinqui he b ate Time Received b Remarks: <br /> Relinquished by Date Time Received by: �IO�i1�JOj���'J V✓�` 'J <br /> Relinquished by Date Time Received by Laboratory: Bill To: <br />