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CHAIN OF CUSTODY / ANALYSES REQUEST FORM Z/2— <br /> Project <br /> 2— <br /> Project No. : Field Logbook No. : Date Serial No. . <br /> 41116's <br /> So �► rQ o}r N� 17560 <br /> Project Name: Project Location: <br /> rifSampler (Signature) ANALYSES Samplers: <br /> SA PLES 9 �O �•� OhT <br /> LAB SAMPLE NO. OF SAMPLE <br /> SAMPLE N0. DATE TIME <br /> N0. "'— TYPE N,� REMARKS <br /> TAINERS v <br /> W X X <br /> XLf✓N6 /Ck/C <br /> - o� <br /> PIPP-10-6138 600- 6q40 LIO X X <br /> PP- - B? i <br /> IPP 09--faH ala} 0&-so W k <br /> -X&lk D91102ureC�. ��s f� oze <br /> RELINQUISHED BY: DATE TIME RECEIVED BY <br /> (Signature) �� PII`i e>760 (Signature) ` DATE 7 Ti�1E <br /> RELINQUISHED BYt DATE TIME RECEIVED BY. DATER TIME <br /> (Signature) _ (Signature) 09l <br /> RELINQUISHED BY• DATE TI E RECEIVED BY: DATE TIME <br /> (Signature) (Signature) <br /> METHOD OF SHIPMENT: DATE TIME LAB COMMENTS: <br /> Sample Collector: LEVINE-FRICKE Analytical Laborator <br /> 1900 Fbwell Street, i2th Floor <br /> Emeryville Callfom la 94608 <br /> - (510)6524500 <br /> Shipping Copy (White) Lab Copy (Green) File Copy (Yellow) Field Copy (Pink) FORM NO. Bb/COC/ARF <br />