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s <br /> I <br /> 111 illFillAll I <br /> ' �ENV/ArQNMENTAi SE17V 1NG ++ <br /> CHAIN OF CUSTODY RECORD <br /> 1JOrihern Callfornl0 offlco , <br /> _ A. 372• <br /> NAME 3637 DATE <br /> ADDRESS t,[��»._ I L' PAGE r 0'r <br /> PARAMETERS OTHER <br /> 2 3 i WAMETER KEY: 1C•TCC <br /> 4 S 6 7 8 9 TO a D a KETALS (16) 0. <br /> PROJECT 0 0 0 2•i'R. LUTANT METALS (13, 0•. <br /> fc �� 0 3•GEHERAL ERALS ' <br /> SAMPLER'S NAME ;``? 4.01L d GREAS 0 <br /> (print) 1 ( Z -� T 5•PETROLEUH HYORp'ARiONS J 0 <br /> 5•BASE/NEU/AC D5 (ORGAN CS 0• <br /> (signature) '.cL y l 1 A 7-PESTICID�s' <br /> r [ <br /> sampleB•VOLAT ORGANICS (501!6 2) 1::. . <br /> l L 9.Vol TILE ORGANICS (524) \•. 11 " <br /> dote Time !Drat.p orS �x <br /> ., 3AB <br /> 03SERVATIO9COMMENTS F 1 <br /> Cr <br /> 1r � f•Lc�U [ L <br /> r- <br /> RELma i NEO .BY: fsnatu a RECEI ED 8Yi (sgnet�re) <br /> 1' id t time TOTAL HUMBER Of <br /> I• �`19lG v ! y.Ca CONTAINERS THIS SHEETt j`� <br /> 2• 1191Gr ) fL f/� <br /> HETHOO•CF SHiPHENTt <br /> 3• SPECIAL SHIPMENTMANDLINO <br /> 1c' 4. 0.1 STORAGE REQUIREMENTS: <br /> DISPATCHED BY:(sign4-a 71 <br /> ature) dat'; time RECEIVED FOR LAB BTt(sla) dot• time <br /> r sl <br /> L wj� .vr 11 <br /> a� mw •;�` ,� �a i=ce ..: � a � :r� ,._Js� r � �,. �" ',. , <br /> i <br /> MEN <br /> r�Is <br /> f <br />