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ERM CHAIN OF COST Y RECORD <br /> est, Inc. • 2215 <br /> 1777 Bolelho Drive, Suite 260 . Walnut Creek, CA • 94596 • (510) 946 0455 . FAX (510) 946-9968 Page Of <br /> PROJECT# PROJECT NAME <br /> C76 -&J G a 0 - 5 c L-k� MATRIX REQUESTED PARAMETERS <br /> ll CC77 . w <br /> SAMPLER (PRINT NAME) (SIGNATURE) <br /> Ck;ti f ��' r 1� �y • 4L fi <br /> �t,4 RECEIVING LABORATORY-1/U <br /> SAMPLE 1 D DATE TIME SAMPLING uuli� w SAMPLING <br /> u c7 <br /> METHOD a> t VOLUME <br /> a <br /> CT-3 7/191 <br /> 1715 ����- s Y u� 3 pC D` <br /> n?�-Sq D 1 i t i 1 3 o� oc GC oc <br /> V97 <br /> N2to'3 <br /> MSI- 1 op13 x oc 0< of <br /> M ^�AD J� �C DC OC' SC <br /> f YoT 13 K <br /> rl <br /> RELINQUISH D BY(SIG TU Et DATE TIME RECEIVED Ba(.__ DATE TIME FIELD REMARKS <br /> 91 (51 x% <br /> RE�UI D Y(SIN E) DATE rTIME RECE VED BY DATE TIME <br /> RELINQUISHED BY (SIGNATURE) DATE TIME RE EIVED BY DATE TIME <br /> REMARKS ON SAMPLE RECEIPT ERM REMARKS <br /> SEND REPORT 1jp• Dr S'14l <br /> © <br /> BOTTLE INTACT ❑ CUSTODY SEALS ❑ CHILLED `�[ <br /> ❑ PRESERVED 0SEALS INTACT <br /> 11 SEE REMARKS { Lo (r[r� 7�p C'tI'iS <br />