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Staal, Gardner & Dunne, Inc. <br /> Consul(iug Engineers and Geologis(s CHAIN OF CUSTODY RECORD <br /> -.121-Norlh_Fir-Sfrect-5trifc+- C i6 r) ()!;V"-) Date ( � j 1"1 ./" -page�ol� <br /> Ventura. Califorma 93001 (805) 653-5556- (,CO 1/.bL <br /> CLIENT GI,nIL �QuT <br /> PROJECT MANAGER <br /> ADDRESS 5+)o C. 1 1 t_,r '•r..•: c r\ ,,, . .•., . . • L <br /> i_''nl / h PHONE NUMBER <br /> PROJECT NAME SAMPLERS:ISlgnaluro) , <br /> SAMPLE TYPE <br /> SAMPLE LOCATION DATE TIME WATER AIR SDLID NO.Or TESTS <br /> NUMBER DESCRIPTION r omp. re f CNTNRS REQUIRED I <br /> IOhl`)c. Iluu (9Dq 3 \ I CI'/1 �i2yU/�iG< vNotl. IT�r <br /> 80 0 <br /> 41 a /• NAi(1" <br /> 74 ZILI <br /> v t <br /> 17 <br /> ( Relinquished by:(Signature) „ r Received by:(Slgnoluro) ,.i' Date/Time <br /> 0 <br /> Relinqushad by:(Signature) -J Received by:(Signature). J Dale/Time <br /> , I <br /> 1 /I <br /> Relinquished by:(Signaluro) Received by Mobilo laboratory for lield analysis: Dale ime <br /> (Signature) 1t <br /> Dlepatched by:(Signature) Dalo/Time rolved for Laboratory by: Date/Time <br /> Method of Shipment: <br /> Special Ins�U/ucctions: <br />