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# • • <br /> Ow �qhk North State Environmental Analytical Laboratory Chain of Custody/Request forAnalysis <br /> Phone (41 5) 588-9652 Fax (41 5) 588-1950 Lab Job No Page - of <br /> Client r _ r* Report to Cti-�-G� Phone r�-,U G _��o� Turnaround Time <br /> Mailing Address Billing to Fax />0 <br /> / PO f,Billing F3 Terence Date <br /> Gti�o.�G,k•r� (fry ��� o Sampler />7— <br /> Project <br /> Project 1 Site Address Analysis ` <br /> Requested <br /> Sample ID Sample Container Pres Sampling Comments/Hazards <br /> Type No 1 Type Date/Time f\ <br /> i,//— S ' S� / i - z 9 <br /> 1j <br /> Y4-r " % vo•st x x <br /> Relinquished by Date �Pne 1 Received by Zft St Lab Comments <br /> Relinquished by Date Time Received by <br /> Relinquished by Date Time Received by <br />