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t <br /> EXcelchem 500 Giuseppe Court,Suite 9 <br /> Roseville,CA 95678 CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br /> Environmental Labs (916)773-3664 <br /> Project Manager: Phone#: 997042 <br /> 1k ) Q-,e � L r r q —7 ANALYSIS REQUEST TAT <br /> r <br /> Company/Address: w. . . <br /> f / FAX#: _ <br /> L'e rV-el� 1 Q l)D / TOTAL(r) Y <br /> �n 3 <br /> Project <br /> Number: P.O.#: Project Name: � U r t o <br /> D V U I S LIP ` p LLl r h L Y <br /> I � m a 111 0 <br /> Project Location: Sampler Signature: � m °D w w <br /> l` o `Q�' °C o a > �1 > > <br /> a`0 m m 46 co d U p W W <br /> Sampling Container Method Matrix N m m o 0 0 o a o o o T - > N <br /> P 9 Preserved, � - � " s N � � � � � > � � <br /> Sample � _ _ 00 oV 8 ;t Y � oa _ UJ <br /> v o le �° °o �° � U v w Q <br /> ID DATE TIME w g ~ z r x o p 'o o N N Z a Q V w Z <br /> v� w w m = ro ro w cc a = <br /> Oa w g-J IL zU, a w w r x t�pp a a a a a a a �e a ua� N a a <br /> N - J 2 S U z N m m H H H F- O► W w w w w w w O Q U w J � W <br /> -► a669 1,s` S <br /> 10 <br /> Relinquished by: Date Ti Received by: Remarks: ALV <br /> ,.�o-� a 1�►197, .e� <br /> Relinquished by Date Time Received by: (9'y1 Cdr a�v/Q� <br /> Relinquishe Date Time Receive laboratory: Bill To: <br />