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= M r r = IM M M <br /> 2t;�R! �a'var�cc � C7�� .r���rn�i�G�-�I t2 c� <br /> CHAIN OF CUSTODCl4ORD <br /> fib <br /> ElMirofYnalm /Professionals <br /> Dale �`' Page ti of <br /> �•� <br /> lo�4 11303 West March Lane, Suite A-5tockton, California 95247-(209)955-4284'%� <br /> 3q-7 E <br /> Client LeJ CGL Pro t Manager���,.� Tests Required <br /> Phone Number / <br /> Samplers: (Signature) , Invoice;: <br /> Project Name ! „I p � ,Q �u ll ,�c QG� f,C�c -� ✓� / Geer 7{ <br /> Client ❑ <br /> Sample Type r <br /> Sample Location No. of h � <br /> Number Description Date Time Water Solid Notes <br /> fl Comp. Grab. Air Conts. <br /> 51728 <br /> } <br /> I <br /> 5 1 729 }- <br /> SPL' 3 ,, 0 1 , <br /> , <br /> I r <br /> ARelinqui <br /> urshed Si�ayure] r r,natur <br /> � � r) + date/Time <br /> - 11119h5J �Q•ISrQ <br /> ed by: (Signature) eceived by: (Signatu e) frd �', / ' Dale/lime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for liefd analysis: (Signature) Dale/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Melhod of Shipment: Laboratory Name <br /> Special tnstructions: -- <br /> 17/7• 1 T1 ET � I hereby authorize the performance of the above indicated work. <br /> __ rnnr Cr.nti ,r �iA9 <br /> HUDSPPLUBS �� Cts Fo ., <br />