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CHAIN OF CUSTODY / A..ALY ES REQUEST FORM <br /> Project No.,: - Field Logbook No. : Date: , t _ Serial No. <br /> Project Name: ? Project Location: ! oc 2 013711 <br /> Sampler (Signature) ANALYSES Samplers: <br /> PLES <br /> OF ti env. `b <br /> NO. <br /> SAMPLE NO. DATE TIME LAB SAMPLE CSN- SAMPLE q� q� �� ¢ <br /> NO. TA 1 NERS TYPE `t• a REMARK'S <br /> iii -- <br /> Is hn'a <br /> �- <br /> RELINQUISHED Y: DATE TI E RECEIVED BY f <br /> (Signature} K3�'�r .a (Signature) / DAF TIME <br /> RELINQUISHED BY DAT 1 E RECEIVED BY ti TE E <br /> (Signature) 'G'i�e (Signature) <br /> RELINQUISHED BY. DATE TIME RECEIVED BY: <br /> ATE TIME <br /> (Signature) (Signature) <br /> METHOD OF SHIPMENT: DATE TIME LAB COMMENTS: <br /> Sample Collector: LEVINE-FRICKE Analytical Laboratory: <br /> 1900 Fbweli Street, 12th Floor <br /> Emeryville,California 94608 <br /> (510)652-4500 <br /> Shipping Copy (White) Lab Copy (Green) File Copy (Yellow) Field Copy (Pink) FORM NO. 86/COC/ARF <br />