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200 Top 0g4w 0G ? 1 E <br /> Treadwetmlo CHAIN OF CUSTODY RECORD �a9a�of� <br /> Envirortmunraf and Gcorechmcat Curtsuf:ant _ 555 MontOomery Street,Suite 1200,$-1 is FronGlsca,CA 94111 Ph:415•.955.90401 Fax:415.955-9011 <br /> 2 Thealrh Square,Sulte 216,Orinda e94563 Ph;925.253.44801 Fax:925.2534985 <br /> /'� 501 141h Slice(.3,6 FIcor,Oakland, 94G12 Ph:510-87445001 Fax;510.874-450T <br /> Sita Name: t�OA ebt,(t Q <br /> Job Number. d��-7 lysis'ReAjuested <br /> Projact LlanagerlCont :i.L et A <br /> Samplers; t .•®r, <br /> M., <br /> Recorder(Slgnatur,r Required); No,Containers ' <br /> Matrix 8 Preservative t13 <br /> Field Sample o a' c`i a a`s ` <br /> Identification No, Oato Time Lab Sample No. _ , z .i RomarkQ . " j <br /> E �-�l�P0 <br /> r. LJ41 <br /> t" L <br /> CPT I <br /> SP- <br /> t Cool <br /> EYE <br /> Rc:,nr,w= 'IgnaSur } NIL, Tm Received by!(Signature► n Da T.ma <br /> C�n !1d � � <br /> Rtiliqui: y.(Si3nalure Dale Tmo Rcc ;Si.r.a <br /> oiv-W by: lurv� Bate Tirna <br /> R0ncui e,J LT.(Signalura) L'atn Time Rera,ved by Lab;(Signalwo) Oalu Time <br /> Sent to Laboratory(Name): i5lalhod of Shipmant 111.ah courier DedEx ❑Airtwme Duns <br /> Laboratory CommentsWotos: Hand Gamed❑Prtvate Courior(Co,Name) <br /> White Copy-original Yailow Copy-LaboratoLaboratory PinCopy-Field COC h+U )ber; Q 0 3 3 8 6 l <br />