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MOMWA <br /> CHAIN OF CUSTODY RECORD <br /> SAMPLERS:(S7pnrfure) <br /> t ,T SHIPPING INFORMATION ; <br /> P.., ne:�7 <br /> SF _a a — _ — Shipper —,-"— <br /> r: <br /> Address JC �� <br /> Dale Shipped ' <br /> 'a Shipment Sorilco <br /> r " <br /> Alrbill No. --- <br /> A `ENTEON; ,J J Vic/"' _ Cooler No. <br /> Phony NO. _ �--��-`� � J r1 ' - ,. <br /> S'.knqulehed by:(Slpnalure) <br /> Received by:(Signature) ate Imo <br /> I' Dalefflme <br /> Relinquished by:(Sfpnarure) Received by:(Slgneluro) <br /> li <br /> Rf.tnqu[ahed by:(stpnerure) Received by:(Sfgnalure) DaterrIme <br /> Rd nquEshod by:(Slpnafure} RacaEvo for iaborattory by:(Slgnarura)' Rhte Imp <br /> ''.n '•J <br /> /^ •.. f l;5�./'. .. fir; .: :.. <br /> Analysis laboratory should complete "sample condition upon receipt"section b#10W, sign and return top copy 4o <br /> Canonla Environmental Servlces,&3 W. March Lane, Stockton,Ca.95207 <br /> Analysis Semple Condition <br /> Sita Date <br /> ~Sample Upon Recq — <br /> Number loontillcatlon Sampled -_ R© uested <br /> ) ! <br /> 17. <br /> J � <br /> r . <br /> Wnits•9unpler Gansry•nalurn ropy To Shipper <br /> pink•Leh Copy <br />