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KLEINFELDER <br /> PROJECT NO, <br /> NO. PROJECCT/NAME RECEIVING LAB: <br /> //Lr <br /> f lfJ 6P 7 y ` l TQC � NO. TYPE <br /> L.P.NO. SAMPLERS:(SignatureMumber) <br /> (P.O.NO. J-sq y /IzV"KrCA 7 & ` OF OF 1 <br /> INSTRUCTIONS/REMARKS <br /> CON- CON- <br /> DATE SAMPLE I.D. <br /> TIME SAMPLE TAINERS TAINERS <br /> t.D. MATRiX <br /> MM/DD/YY HH-MM-SS <br /> 2 <br /> 3 <br /> 4 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 F <br /> j <br /> 17 <br /> 18 <br /> 19 <br /> 20 <br /> Relinquished by:(Signature) teTme Received by:(Signature) Instructions/Remarks: ^ Send Results To: u,�r <br /> Relinquished by:(Signal re) Date/Time Received by:(Signature) t 2825NEA5T MYRTLE STREET <br /> STOCKTON,CA 95205 <br /> (209)948-1345 <br /> Relinquished by:(Signature) Date/Time ReceivedforLaboratory by:(Signature) Attn: n' <br /> M-60l -1 <br /> White-Sampler Canary-Return Copy To Shipper Pink-Lab Copy <br /> CHAIN OF CUSTODY NO 1 7 6 6 `'� <br />