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rl� rr. rr rr � r �■■� +• � lr r r rr r r r 4r r� � <br /> S i1"I-)TIC"f C eo U1 VI K0n►nC41-(- <br /> CHAIN OF CUSTODY RECORD <br /> bate � .� page . 4— 01 <br /> &7vmonmenfa/Prolessiona/s <br /> 6mow 1803 West March Lane. Suito A- Stockton, California- 95207 -(209) 956-0264 <br /> r <br /> Glientpp�� Project Manager <br /> pb l Q ft ` Tests Required <br /> Phone Number <br /> coon) nr��c��'��� <br /> Samplers: (Signature) Invoice; <br /> /1tELc)r�Cr'CT Cape <br /> Project Name <br /> Client ❑ <br /> Sample Location Sample Type / <br /> Date Time Water Solid No. of <br /> Number Description Air Coats. /Q Notes <br /> Comp. Grab. <br /> 1 <br /> J193 . Z3'3 5 -- - 1 " 1731 <br /> .511 7J Z <br /> e ingk a y. (Signature eccl y: (Signature <br /> Zr DaelTime <br /> lo,inqu,shod by: (Signatutc) ltocaivod by: (Signature u1��26-a�� G( T70 r *-1' <br /> lmo <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Dale/Time Received for Laboratory by: Date/Time <br /> : <br /> Method of Shipment: f •�. LabAoralory Name <br /> JIM <br /> Special instructions: tL I <br /> M7 tik A�� vr� ul <br /> 1(,,.r� T 1 hereby authorize the performance or the above indicated work. <br /> 1'�°i,�}Sf'r,CE�•��.;�rP�rw CbNTPtlAf.�� �' <br />