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CHAIN OF CUSTODY / A..ALYSES REQUEST FORM <br /> Project No. : Gf ! - Field Logbook No. : Date. _tU`�t Serial No. : <br /> Project Name: C) C't'' t Project Location: (; N? 01� - <br /> Sampler {signature) ANALYSES Samplers: <br /> SAMPLE NO. DA7E TIME LAB SAMPLE NO. OF SAMPLE P ),CON- <br /> � k <br /> NO. TAINERS TYPE {` �( REMARKS <br /> RELINQUISHEDY: DATE TI E RECEIVED BY: t'" DAT TIME <br /> (Signature k/ A:)._,; ', (Signature) <br /> RELINQUISHED BY DAT t[ME RECEIVED BY: c <br /> (Signature) (Signature) ` TE E <br /> RELINQUISHED BY. DATE TIME RECEIVED BY: <br /> (Signature) (Signature) ATE TIME <br /> METHOD OF SHIPMENT: DATE TIME LAB COMMENTS: <br /> Sample Collector: LEVINE-FRICKE Analytical Laboratory: <br /> 1900 Fbwell Street, 12th Floor <br /> Emeryville California 94608 <br /> (5110)'652-4500 <br /> Shipping Copy (White) Lab Copy (Green) Fite Copy (Yellow) Field Copy (Pink) <br /> FORM NO, 86/COC/ARF <br />