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li A R T ifT E C R Chain of Custody Record - Labjobno. <br /> @ Pate <br /> Laboratory�,� � ��"S Method of Shipment—� — <br /> Pae —of 1 <br /> Address 66 WAI l'S'f `t R VL- LW7 IZShipment No. Analysis Requested <br /> VATF"921 D_ftATAUPSA*-MA <br /> Alrbill No. _ <br /> Cooler No. <br /> Client <br /> Address r �w Project Contact C�JS ,� — <br /> e t <br /> C <br /> A*� Telephone No.0 o 3 2�SSG D <br /> Project NameTpFrt145 �pfc►Ma�'f ST-Fax.No. �° ,1-32—2 0 _ s° <br /> Project Number (a�-T�1 o Samplers:(Signature) <br /> Sample Sampling samplkq Type/Size Preservation -� Remarks <br /> Field Sample ID Matrix. Depth Interval Dale Time of Container Temp. Chentical <br /> MWS—o(ol�a6%—Grw 1 W <br /> Mw — o(ol(ov�-awLv <br /> Relinquished. Dale Received by: Date Relinquished by: Date Received by: :: le <br /> ��_ Signature g <br /> Signature _ Signature Signature 61 <br /> 9 <br /> Printed - � _— <br /> Printed ,. <br /> Time Printed — Time Time Printed_L1" �'�` Time <br /> i Company <br /> Company �r�� L�..f�I S 7,0 <br /> Reason ro ^EU'� Company Reason Company _ (� <br /> L Relinquished by: Dale Received by: Dale <br /> Comments f�^� - ���rati"�S�"'�J—�~ 2- Signature —_ <br /> Signature <br /> Printed — - - <br /> Time Printed— _ __ Time <br /> Company <br /> Reason Company <br /> DISTRIBUTION: While to Laboratory.Canary to Earth Tech Project File.Pink to Field File - . <br />