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CHAIN OF CUSTODY R C �JJ� o �7 <br /> ERM-West, Inc. <br /> 455 Capital Mall, Suite 800 • Sacramento, CA • 95814 • (916) 444-9378 • Fax (916) 444-5313 Page 1 of <br /> PROJECT# PROJECT NAME MATRIX REQUESTED PARAMETERS <br /> , 318'co 11115 - ,S�' <br /> SAMPLER (PRINT NAME) (SIGN TUBE) <br /> A--- <br /> RECEIVING LABORATORY <br /> SAMPLE I D DATE TIME a SAMPLING Uj w? SAMPLING <br /> U a: METHOD ¢� v> VOLUME V <br /> a V <br /> 1� 5S f� - <br /> Ink) <br /> fiUo-5A <br /> ini4j-,2A jib-k-5 092;� ? <br /> .y mij -1 A e,Ds,5 <br /> x . <br /> IY?Gv - I3ss <br /> c� ri1W-5 r5 <br /> RELI DISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE TIME FIELD REMARKS <br /> LINQUISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE TIME <br /> RELINQUISHED BY(SIGNATURE) DATE TIME RECEIVE "BY DATE TIME <br /> f2u)c"4 <br /> REMARKS ON SAMPLE RECEIPT ERM REMARKS SEND REPORT TO <br /> ❑ BOTTLE INTACT ❑ CUSTODY SEALS ❑ CHILLED <br /> ❑ PRESERVFO ❑ SEALS INTACT ❑ SEE REMARKS <br /> WHITE-LABORATORY COPY CANARY-FIELD CO PINK-DATABASE MANAGER GOO.D-P00JECT Fh F <br />