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�. --I%nCLL V1L I.VLVIf'A111YC CHAIN OF CUSTODY RECORD Da ",I-F86-Q8 <br /> `.TAIL. ENVIRONMENTAL _ NL <br /> ENGINEERING WEST Ser[al No. Page / o! <br /> Slle Address; <br /> 1�l6-7 (6g%1j-v t{ub �L�c� fi0 cis 1`�� Analysis Required LAB: ` b <br /> ICO.- 204-75a (75d rb GIIECK ONE hOX ONLY VIN1URN AROUND TIME <br /> Shell Englneer. Phone No.: 510 G.W. Monuodnp ❑ 1161 24 haus ❑ <br /> ( -Z Fax -Sa�`a Z Sr•Inv/llpolan ( cul �5hoLn <br /> Consullani Name&Address; p ❑ `��� <br /> M Sall clolluv/akpolol I i days ®{Norman <br /> 10ambria, P.O.- Box 259, Sonoma CA 9 4 6 <br /> WOWConsuRanl Conlacl; P11# 707-935-4854 c o �, ctar.uyfnl/polol 0 4443 ah•I ❑ <br /> Joe Neely Fax: 935-6649 g `1 0 Mk Rem,or Sp, L-1,4412 <br /> Comments: O o 4 `o . s <br /> NOTE; Nollry lab w <br /> -d ,� 0 O;M Rem.or syr. ❑ 4463 1oan aI pal IkAG of <br /> b 2414M hla. rAL <br /> Sampled by: J� , , m a Olh•r ❑ <br /> 2 co 4 0 �- N D UST AGENCY: <br /> Primed Name: Jot NW* <br /> - , a '- <br /> a m c n 4) o, <br /> ffo.o E R MATERIA!. SAMPLE <br /> Sample ID Dafe sludge Soil Water Ali aonlsr j ,0 U �f � Q di o DESCRIPTION CONDITION/ <br /> COMMENTS <br /> -- -Y3 <br /> 5 a_ to <br /> n gnu o);....--. Rini Nn <br /> �.�.� :-_ � — -=---F:�Dais- ° - - - R ad <br /> .. � 0 fore): Pi pled Nct��rlra: -- - - Dal <br /> (d <br /> - P <br /> 14 4ik <br /> I (EI nahxr!): Print Na Dafo: "z Received(rdpnalu ): <br /> Print Narlle: - <br /> Gt t`t Do e, <br /> f Time: <br /> By l Onahmol. Prin ed flame: Dain: ReceNed(ds�na re}; Primed dame: <br /> Thne: coca Dais:1- <br /> Tine: I I Ll p . <br /> • hMpQ+l of Woad. <br />