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F­ r r r r r r r r r r r r r r r r r <br /> Mygienetics r�t <br /> Environmental SF <br /> Chain of Custody <br /> 711 � a. <br /> Date—! Jb �✓ Page_i.-. Of <br /> Lab Name /AC'� a- ),) L160, <br /> Analysis Request <br /> Address 11 p—2"( VY.I� B .G�if7"�_— I IT <br /> Telephone C � 7�j1 I n N <br /> h I o I d I I — a <br /> o 0 o a` a E w Ep V i � I a I E j I I E c n c <br /> Samplers SiGh1�T RES - m - a c>g o m m U z I m n m <br /> _ N 0 C <br /> /! �� ~o �' and oUINO wIrl rndl .a wm oylmi o� U � <br /> (✓f. / i N 'O N Or F- > V j iA d N ~ O 'j �• y N 1b <br /> i i4, d ? C d <br /> C Q '^ n N U 4 O ti C D v <br /> t) tp I E N z b = N y0 I J J ¢ N b d N N N N <br /> Sample Numbe Matrix i Location =�'a a a m I� j a o f r r ti ¢ a 1 F ti ci a u m z <br /> -�'��-_S► ,��Q� z Sr�t Nab 1, W � <br /> , I <br /> Mon <br /> - - - - ----- f - - - - - - — - <br /> _�� 6-1.1 Ofiy 6a)at <br /> ,--b) I'� �! °�" �' >'l�►DJs-erl �r j j v(ns o� - - <br /> - -- -- t� -- - - <br /> `� I W.�!)tic ND T101,' _ PPOOP rF, _ .. .. <br /> - ---- _ -- - - - - - - ------I -- - <br /> 1 'A( . AIl9htT - - ON4AiN RS <br /> RIN TIEDjIN 3 PRTsyER IET�I <br /> Project Information Sample Receipt Relinq ied By 1. Relinquished By 2. Relinquished By 3. <br /> Projectthl F 11 >. Total No.of Containers - --¢� �-`�!(�-� 7 --- ----- - - - - - - --- -- <br /> I LY Vii n Chain of Custody Seals <br /> (Sit�, r �] e) )slgnanne) (rime) {Signature) (rme) <br /> Pro'ect Director G�i1 y JCC }- w r��'1tf Y)t yJ34� <br /> Charge Code No.t-Ji ) .603 Recd Good Condition/Cold (Prm ed (Date)(Date) (Printed Name) (Date) (Printed Name) (Date) <br /> -Shipping-ID.No. Conforms to Record -"' --- ----- <br /> I {Cornpar ) (Company) (Company] <br /> Lab No. Received /�� I. Received By 2. Received By(Laboratory) 3, <br /> Via: f, I f71 <br /> --- —.. <br /> (;Ime) (Signature] (Time) (Signature) (Ti-.) <br /> Special Instructsons/Comments: <br /> lff r (Primed Name) / (Date) (Panted Name) - (Dace) (Printed Name) —--T (Dare) <br /> ([on+pany `/ - _. (Company) <br />