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The Twining Laboratories, Inc. <br /> '"' CHAIN OF CUSTODY RECORD <br /> Project No. L 686 - / V ! ac <br /> Date/Time Sampled t--1 g - r, -7 <br /> '- Affiliation of Sampler/Shipper <br /> Address Zs7,-1 " F. f•• x'� .�,-cs� GQ ____ _q-T7ZeZA5�L- 7�_Z1 <br /> Number Street City State Zip Telephone <br /> .Collector's Name <br /> Signature <br /> La `V Transported ByDate�Ca1t Shipped P-77 <br /> c.. <br /> Sample Receiver ��..-..� ..iC- <br /> L <br /> Address �+ <br /> �- DatelTime Received <br /> Comments <br /> Collector's <br /> Sample No. Sample Description Analysis Requested <br /> 14 - �,: / zv�to _v, l G►-�. —� <br /> 2 e-1A zf rem 1 <br /> /�3� /S �• _��c,� G; � G,��u-mac <br /> two <br /> Chain of Possession: <br /> 1. y " 7 <br /> Sign ure Affili tion Inclusive Dates <br /> z. <br /> Signatur Affiliation Inclusive Dates <br /> s. 7L. S av--k7 <br /> Signature Affiliation Inclusive Dales <br /> 4. <br /> i... Signature Affiliation <br /> 9 Inclusive Dates <br />