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'Sy <br /> CHAIN OF CUSTODY AND SAMPLE I DENT IFI CATION RECORD <br /> SRM-West 2865 Sunrise Blvd., Suite 210, RarlCho Cordova, CA, 95742-6538, (916) 635-7766 <br /> rccelving laboro[ory: <br /> Went: �3 Pa e: � of: -S Arilab Analytical Lab <br /> tchlson, Topeka and Date: ____ - 1914 S Street <br /> anta Fe Railway Co. Weather: ° `� ° /�"�'` /`� <br /> 770 South Eastern Ave No. of containers (t kis page only): Sacramento, CA 95814 <br /> —1—. <br /> _os Angeles, CA 90040 <br /> Sampler(s): _ _�- =��. (916) 447-2946 <br /> g _ --- / <br /> 3 � IgnALure(s): -1 <br /> BRM~West Jo No a ---- --- <br /> SwVIe Time Sample type - <br /> Containers Preservative Ice Sampling Pnalyses <br /> Y/N MethodID (soil/water) — � — <br /> (grab/comp) 1`10• Vohme Yp <br /> ----- <br /> � <br /> !9_0q sar4 fGR t3 xG r ��'f��S7tlf3� _ t00r!G_ <br /> /' ' - __ I - -- <br /> 2-%1 _-- �__ __ _ _ _ _ _- ._ _______._ _ <br /> LlJ� _ _ ___.........--_ — <br /> 1G x_5'0 _� �.__ _ _.l - �I ? <br /> 8-3 r v [ <br /> Custody Record <br /> C2ME is _—_—_--_---- _—_...-----_. Sig Lure//Dat�e/Time Ss_g_g <br /> —_—_.. —__—__....._._—.------————,_. ——————— Rellnqul� ���`5z <br /> _.---._------_ ---------__.....---.--_---•--- Recevel d _.._..,. ------.�___ <br /> —.____—_.--__—_----------.___—_--------� — Relinquished _ _ _--� <br /> -- .__— .---------------------------- Received �Z <br /> Y. <br />