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i <br /> ENVIRONMENTAL CHAIN OF CUSTODY ORIGINAL <br /> AND ANALYSIS REQUEST DOCUMENT <br /> 'v .� [A/ <br /> Analysis 5 Days 2 Days 24 his <br /> Client Gi Fam.pt (s) _ �Y 1Cti1�J 1 ri•�-J — Subject to surcharge <br /> Customer Number r� �� C report required yes no <br /> Address, onic Dara Transfer yes no <br /> // �^ p ampler Sel up Datc Tlme To State_ ChentOther <br /> Phone c (n! 2-o lO I g3 ! r 2-2- <br /> Mileage umberFAX oc SP 0 STK ❑ VI ❑ D <br /> Project name 2Aeac <br /> Contact person r t^ <br /> Billing Information(if different from above) E+ j <br /> � , G <br /> Name y x a <br /> Address <br /> O <br /> m - O <br /> Phone O i� ti cn u <br /> FAX C' z <br /> u u <br /> u ^ ':5Contact person a G o U -. <br /> Purchase order/contract/FU quote number L9 ' U a 0 04 O <br /> Pre Log Required yes no W z z W <br /> Sample Location/Descrlpdon Date Time 3 u <br /> Number Sampled Sampled z <br /> lb2q 3 V Owl W <br /> [Roctivcd <br /> ilnquished by and su67erAto the kmra and condodont on the mrcr4e orthis doe meat L f <br /> ] L' 1^ If <br /> }I A717-1 Dal !�� _ ,�7(�p Time r " Rclingwshedby Dau Tune <br /> L 'I U Time i Received by Daulinq s by Date Time Rcllnquntkd 6y ➢ate -rr7-1 by Date Time Received by Date 7- Time <br /> CORPORATE OLABORATORY OFFIC8&LAP +TORY FIELD OFF CE <br /> PO STRA B53 Stmet 2504 Stagecoa VW116Cahromia <br /> Stockton CA Tel (209)734 9473 <br /> Santa PsulL CA 9 2 Mobile (209)737 I3" <br /> Tcr t8' <br /> 3)639 091' Tcl (209)942 FAX(21)9)734 8435 <br /> FAX (805)525 4172 FAX (209)942 _ _ _ aaaa <br /> _-- <br />