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I � , <br /> Chak. 0' 1 ', S bay ' <br /> ANALYTICAL LABORATORIES, INC. Date �.f0 /r'G Page 2 Qt _� a <br /> PROJECT NAME STa� M� �1 �k�� _� C GC/MS INORGANICS OTHER REMARKS ' <br /> LLP <br /> PROJECT NO. <br /> SAMP ERS(SIGNAT REQ a l cr z C <br /> C � � <br /> i >C Z. a) LU 0 <br /> c N 0 ,ted, t- U to z ¢ <br /> i m m (3Cm ago , ¢ •q U m <br /> PRINTED NAME (LC)o n o U � N� ? J <br /> r. Z3 <br /> h m u7 tD w IL (O (a C <br /> SAMPLE NO. DATE -TIME LOCATION <br /> it T` +i(' �•�� r <br /> X 't <br /> -! 7 <br /> 2 I , b. r..l x <br /> itiW-.1 <br /> w-2 Irk : <br /> IX I <br /> hl{U- <br /> RELINQUI:SHED BY DATE CEIVE pY DATE RELINQUISHED 9Y DATE RECEIVED BY DATE TOTAL NUMBER <br /> ` !i OF CONTAINERS I . �, <br /> S' Lure _ le S nature 61t110 Signature Signature METHOD OF SHIPMENT <br /> 1 <br /> Prih�Name` /71ME Printed Name a 1�T TIME Prirated Name TIME Printed Name TIME $ <br /> SPECIAL SHIPMENT HANDLING <br /> Ipl� <br /> Company lvew'F v,'v'r ICompany Campany Company OR STORAGE REQUIREMENTS 1a <br /> RELINQUISHED BY DATE RECEIVED BY DATE RELINQUISHED BY DATE RECD By(LABORATORY) DATE <br /> Signature Signature Signature Signature t <br /> Printed Name TIME Printed Name TIME Printed Name TIME Printed Name ' TIME a <br /> Company Cany ompCompany Company <br /> 60OW North Market Boutevard Sacramento,CA 95834 Phone(916)923-0840 I5 <br /> it <br /> IS 11 11111 <br /> ,.. <br />