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Excelclen 500 Giuseppe Court Suiie 3 <br /> Roseville CA 95678 AN-OF-CUSTODY RECORD AND ANALYSIS REQUE <br /> Environmental Labs Ph 916 773 3664 Fx 916 773 4784 <br /> Project Manager Phone# Electronic Data Deliverables Request <br /> frl / ✓I/��---- 7%Z Global I D # Email Address <br /> v <br /> COC # <br /> Company/Address r Fax# <br /> location I D # � <br /> � J <br /> ANALYSIS REQUEST Pa e of <br /> Project Number/P;O# Project!Name <br /> Wet in# <br /> rn Total Due Date <br /> �p+ <br /> Project Location Sampler Si pature o n m N (p'2Z7 <br /> o b <br /> y o ca <br /> CD m <br /> cD c0 N � U <br /> r W LU L!] <br /> Sampling Container Method Matrix Q a N N <br /> Preservedo m in 0 U <br /> Sample cInN � co N � � � 3 Z <br /> woo N m �D W W s C L y H <br /> ID N - � N a <br /> Date Time �, n v a o 0 o od �, oca <br /> _ w <br /> W � c*} LLf w w m � O v u m cn <br /> w J ¢ CJ z w in T O Q O H n= o ai U O `m � `a LAB USE <br /> ,- a r = �? z cn a m r F a ui °i in U � rr ONLY <br /> VO -3 WDIvOu�bb <br /> V V/ <br /> Vrj'1 -G <br /> wo�o04W <br /> EV�4004J10 <br /> Relinquished by Date Time Received by Remarks/Condition of Sample <br /> Relinquished by Date Time Received by <br /> Relinquished by Date Time Received by laboratory Bill To <br />