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ag/- <br /> SAMPLING/ANALYSIS REQUEST AND CHAIN OF CUSTODY RECORD <br /> j <br /> I <br /> Project No.: 02 <br /> Req Uested BY: f <br /> 4 <br /> REQUEST <br /> LABORATORY REQUIREMENTS CHAIN OF CUSTODY I <br /> SAMP�E ]YPE: ( "r <br /> CONTAINERS M L RE <br /> SAMPLE I.D. >COhITRACT LABORATORY <br /> PArWAUFRS SIZE/TYPE OUANTITY DUE <br /> ' PfTES. LAB <br /> SAMPLETI <br /> Ml c�.:e t_ u� DATE SNdPLEDATE ITEC'DPY COMMENTS DAT@ <br /> Jol��*� <br /> u� l e ti RECD i <br /> �_ 1[ oCo�-brn.$ ��4,•.t�,�(' � � ��'�I �Crl J SC ���_� j _..�7 . <br /> — O <br /> I <br /> %nnom b.Cse 1 !7 % <br /> Cr QC-li� pro ,yY� — /ftf ReLl, <br /> (C nC) <br /> W%Uf <br /> W <br /> SIGNATURES: <br /> i ���J'L AFI J�f��,�"5 �, r'�--`t 'l�—G'fy�.lL. L•c' i_.f I'}r 1--CJ� a� <br /> Il q! ulrriglr�<� F f{'Y ISiy�{rain Orq i Ilan <br /> i r Daw/liute Ile rived0y{sign lurel <br /> ,_ Ile dr onira i n Dalo/TImD Turn Around Time <br /> ca rquished(iY ISigngwr I I Orga' is�lia t-1'I/ <br /> Dale/Tima say 'ff )frcie choical <br /> I ) r f 4eceived py{Signalurcl Orgonixalion Dala/TimD <br /> 17 /,srl '1�u�1° 4%Gy3J I 24 Ilrs <br /> ReGru urshed 1! L t�F1'Y71C� 4©IIrS <br /> ! ylSrgne ural � Organization US^' <br /> Dote/ Ima lteceived For LaSDralorY By lSignawral 5 Days <br /> � Delo/Time <br /> li; Oil <br /> c <br /> 3 <br />