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CHAIN OF CUSTODY RECORDo2Co <br /> DATE J)F-C• --?C, I 5JrPAGE 1 OF � Environmental <br /> PROJECT NAME k,�uN�6ccNlrJNi+ � ANALYSES TO BE PERFORMED MATRIX Science & <br /> i ADDRESS N C Engineering, Inc <br /> 1 M U O A coon►e..o.., <br /> 5,rbcic+rvJ C A - A - -- ---- <br /> �, T B T 4090 Nelson Avenue Phone(510)685 4053 <br /> PROJECT NO. (0 542o <br /> R E A Salle) <br /> v " I R Y Concord CA 94520 Fax(510)685-5323 <br /> SAMPLED BY C +utA-:, UA,,t_c-uj X O <br /> LAB NAME h,lcC.i,,.-,p F R REMARKS <br /> S (CONTAINER, SIZE, ETC. ) <br /> SAMPLE # DATE TIME LOCATION Pa MATRIX <br /> UST-- 1 jZ-7o-kr 151 e0 smicm'j YX i4 tucks 1 hL. - (4- -oma t -. <br /> L _rl <br /> �- vyr- 14 <br /> VOA MG Mz,, [ 1,a ER 1 <br /> �cr <br /> AIDSF 1I fn IN <br /> REL UIS D,f. nat+lzre R CEIV BY. si nat~ure date time 1(, TOTAL NUMBER OF CONTAINERS <br /> 1. REPORT SPECIAL SHIPMENT <br /> 2. RESULTS TO: REQUIREMENTS <br /> 3 . <br /> 4. <br /> SAMPLE RECEIPT <br /> INSTRUCTIONS TO LABORATORY (handling, analyses, storage, etc. ) : CHAIN OF CUSTODY SEALS � <br /> i <br /> REC°D GOOD CONDTN/COLD <br /> -T ✓o c�r� �r� 4n a, ,-t p =CONFORMS TO RECORD <br />