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Chain of C stody Record � n- ite 'll'me: 'Temw <br /> bp Project Namie _ —h e(,ta �Lf� f9=811e Time: 7'e:rep: <br /> R EMPortfolio:F li <br /> 13� �]f�x COCQ i1 t � 0+ � Sky Condikfons: <br /> 1lP Laboratory Contract Number; tifeteorviogical livents: <br /> Date: -1. 0-Z— RequWcd Due Date(mmrddlyy) =Wind 17irectfou: <br /> S cud Ta: PlCrEhf Facility No.: ' usu118ItVt'edtra�tor:• /' ' . <br /> i ab hlamE;t` + , 11PICr1iM Facility hddr s: )W7 141,w we, Aav .6 X 1,G, Mdrcsv ri <br /> lab Add ms: Site ID No. IY4,c & <br /> M' ile T aUl,ong: =mail 1'MD: <br /> 'ali(brnia Ulobal 11)gz p7 onsultanV[oniractor ftject Nb.: 3 4 <br /> tab PM: I1Pf('NNI Phi GUniaet: orls%ANT C( ntractorTcle/Fax: <br /> leldihax: Address: 'nnsuStanUE antractor>? is r <br /> Report Type&QC Level: lavaice to: ConsultanilCoutracly; or IIPIGPM (Circle one) <br /> 11111{iU1 Account No 11olcNax: IJPJGHM Work'J eleaw No: • y`[ll.+/ <br /> Tab Bottle OMerNo- Matrix Prmrvathros RtguestedAnslydt. ' <br /> ftsrn �, sample Pdfnt Lat/Long and <br /> Sample 1)caerlption TIm Laboratory X0. <br /> Yo. a ago eq Cbroments <br /> 1 I ) <br /> 2 VLv 7— r <br /> 3 iiv� ' ' <br /> 4 J/tv- <br /> G �r Z <br /> 7 ' <br /> S <br /> 4 <br /> 10 <br /> Samplces Name Cv, 1• Rr' vy tliarian bate rime meted By r AiAUa&& a fide <br /> Samplees Cnalaatty: r � <br /> Shipment pate: 41`,O`Z <br /> Shi picni Method: Nk <br /> SWpramt Tracking o; <br /> SpGalal in�tructlon�: <br /> L1Ustody,Seals In Plncc Ycs_ ..." No _ Temperature Blank Yes NO Cooler Ternperature on Re+capi °K!C Up Blank Ym No. <br /> -LABORATORY DP COC Rcv 1 WSW <br />