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(jL',cAUlt t T CHAIN-OF-CUSTODY REWHIV Wage <br /> Ar&MILLER, INC, Labolelory Task Order No.--,— <br /> ��J<'►ivrrnnnirrrraf SrrvireJ <br /> SAMPLE BOTTLE 1 CONTAINER DESCRIPTION <br /> Project Number � � �' <br /> Pro' flon <br /> Loc n ��� �1V <br /> Laboratory <br /> n ' � r� <br /> Samplers)/Affiliation �. ► <br /> Dateffte "LJ TOTAL <br /> SAMPLE IDENTITY CaJe Sampled Lab ID r <br /> 5 =� - <br /> s 07, .C, 3 <br /> Total�dBOUIO Li <br /> Sample Code: L a Liquid; S Solid; A s Air <br /> Containers r <br /> Date Time Seal Intact?. <br /> Relinquished _ Organization: Tim$ 2 v No NIA <br /> � i Date <br /> ITeceived by: _ _ Organization: __� <br /> Date <br /> LAa`� ---- Sea! Intact? <br /> Organization: r— 10110-9-1 <br /> Ln 'Y Mime—� Yes No NIA <br /> Relinquished bY: �_ _� Date.,1�.L--Y <br /> Received <br /> by: ._ Organization: <br /> �.._ ..— <br /> SpeciallnslruclionslRemarks: <br /> - ❑ Lab Courier ❑ Other SPEC,FY <br /> Delivery Melhod: ❑ In Person ❑ Common Carrier <br />