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1�S GAS <br /> Chain of Custody Form ANALYSIS REQUESTED <br /> Curtis Cr Tompkins, Ltd <br /> 2323 Fifth Street <br /> Berkeley, California 94710 Samplersco <br /> (415) 488-0900 <br /> Job Descriptiondi <br /> N <br /> C V <br /> Job Number_ u <br /> Client Contact �' ��f Recorderinx N <br /> � � V) <br /> m q V V) <br /> r- mro ° mMethod a i d <br /> Matrix v Preserved Sample Number Sampling Date m co w m v p K 0 <br /> N x r <br /> SAMPLE NOTES <br /> -4 - v Ln N41 -4 <br /> o TIC014-0`141 Mo M -H U N Uyr Nb Dy Tlme as wa -Hww ai -4w$ Cn 3 0 �C i+1 41 W W F W F W O W <br /> l <br /> [A ) 019 's ? 11ILSIC <br /> 6 J1 <br /> Laboratory Notes : Chain of Custody Record <br /> Relinquished by:(signature ) Da tp/yr Received by'(signature ) <br /> Q Relinquished by: (signature } DatelHr Recelved by (signature } <br /> Ste/ �rGyt/CiJ GOJ C� ��o Relinquished by: (signature ) DatelHr Received by (signature ) <br /> Relinquished by (signature ) Date/Hr Received by (signature } <br /> Dispatched by:(signature f Date/Hr Received for Lab by (signature } <br />