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CHAIN OF CUSTODY RECORD <br /> DATE PAGE_ OF,-- Environmental <br /> PROJECT NAME ANALYSES TO BE PERFORMED MATRIX Science & <br /> ADDRESS M U 0 <br /> +.C.CORP <br /> Engineering, Inc. <br /> C /'tel (415) 685-4053 <br /> �� SSC 1/ �/ r R E A Suit Nelson Avenue <br /> PROJECT NO. Suite) <br /> � I R I Concord,CA 94520 Fax(415)685-5323 <br /> SAMPLED BY = X O E <br /> LAB NAME � � F S (CONTAINER, SIZE, ETC. ) <br /> KS <br /> SAMPLE # DATEPTIMELOCATION ' ' MATRIXz - lo1� y r sG� <br /> 310 <br /> ­31 <br /> -3z <br /> 1IJ1 RECF VED BY: (pigp ature) date time TOTAL NUMBER OF CONTAINERS <br /> S/ J }"� (yds REPORT SPECIAL SHIPMENT <br /> X92 RESULTS TO: REQUIREMENTS <br /> 3 . <br /> 4 . <br /> 5. W SAMPLE RECEIPT <br /> INSTRUCTIONS TO LABORATORY (handling, analyses, storage, etc. ) : CHAIN OF CUSTODY SEALS <br /> REC'D GOOD CONDTN/COLD <br /> 2 + CONFORMS TO RECORD <br />