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f ` CHAIN OF CUSTODY Ref.Document# <br /> / Page of I <br /> ShaW M Shaw E& I Project Number: [-5-776�. 10 <br /> 2 36" E <br /> Analyses Requested <br /> Project Name/Location: ATtY y <br /> Purchase Order#: <br /> Project Contact: D <br /> KA �/�aQry C��Z��'Z.LD'3 <br /> — <br /> (Flameo prone Shipment Date: 3h llO <br /> Send ReportTo: �`j ��n rD Waybill/Airbill Number: <br /> Phone/Fax Number: X25—Z'b`b' 1,03 Lab Destination: <br /> Address. H_r_S lab Contact N,me I ph M — <br /> E <br /> i= <br /> City; CQ/�CrlT CA 44510, � <br /> Preservative c <br /> Sampler's Name(s): x d Q <br /> c <br /> Collection Information c c J 0 O rp <br /> Sample ID Number Sample Description Date Time GIC ° g ° = z = _ <br /> C- o A54 <br /> "i <br /> Special Instructions: <br /> GIC Codes <br /> QC/Data Package Level Required: C=Composite G=Grab <br /> I II Project Specific: Matrix Codes <br /> Relinqui a y: Dale: t b`l D eived By: Date: DW=Drinking Water SO=Soil <br /> Time: C o 30 Time: GW=Ground Water SL=Sludge <br /> i <br /> ui ed By: Date�// /O eceived By: Dale j_// WW=Waste Water CP=Chip Samples <br /> Time: rime: SW=Surface Water WP=Wipe Samples <br /> Relinquished By: Dale: Received By: Date: LIQ=Other Liquid SOL=Other Solid <br /> Time: Time: AS=Air Sample SED=Sediment <br />