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DATE �' PAGE �0F / AcHAxN OF CUSTODY RECORD <br /> Environmental <br /> PROJECT NAME �� 1 r ALYSES TO BE PERFORMED MATRIX <br /> Science $t <br /> ADDRESS 35 S ` <br /> Let� N C Engineering, Inc <br /> fC IZZ M U O <br /> PROJECT N0. �_ - i R E A S rx`',{.,x� ,wk 11m <br /> (l N) 685-4053 <br /> ;AMPLED BY_:�j,j <br /> X R 1 0 meord,tAW20 Id f{151fvM;ri <br /> SAB NAMES t� — C h��` I 0 E --- —-- <br /> SAMPLE # DATE TIME LOCATION �- � MATRIX F S (CONTAINER, SIZE, ETC. ) <br /> 6- <br /> f <br /> 3 <br /> Z 4 <br /> S <br />� Z <br /> RELINqUI signature) CEIV'ED BY: i atursdate time TOTAL NUMBER OF CONTAI RS <br /> 1• S / �f <br /> 7 Cc.� r�Vv�� � — <br /> 2 • �G��t lU 2.C�-tv�— /TO clF� REPORT' o SPECIAL SHIPMENT <br /> ((OD RESULTS TO: REQUIREMENTS <br /> 3 . <br /> 4 . <br /> _ SAMPLE RECEIPT <br /> INSTRUCTIONS TO LABORATORY (handling, analyses, storage, etc. ) : CHAIN OF CUSTODY SEALS <br /> J� --ISEALS <br /> REC°D GOOD CONDTN/COLD <br /> j C <br /> =POMS TO RECORD <br />