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Environmental <br />/ Deka <br />///A, Consultants, Inc. <br />Sample Identification/Field Chain of Custody Record I �,> <br />Project: <br />Shipped by: 1"J� _l � f• � 1-,6(+�. ✓' �✓� <br />Shipped to: MO d <'_ <br />Shipped <br />Results to the attention of: 1 Re-O"J"ell�-. <br />' + 'yt <br />w.o. �V 9q - <br />l •— Z c7 S <br />Sampling <br />Point <br />Location <br />Field ID # <br />Date <br />l <br />sample No. of <br />Type Containers <br />Analysis <br />Required <br />LJ <br />No4t, 16-K W�c <br />etl_p�a <br />— 5 `!•-y�, <br />5 ��t ga <br />5�;1 <br />i <br />TPO �� g x 2 <br />w'°'V <br />K. e <br />''''�' <br />W - 5^ -7o <br />. , <br />!'SLTOM-G <br />r;x 5r' a <br />T ` � w <br />®Ulfl, K `�' <br />SW _ o <br />, i <br />`' <br />J <br />i Pit 4 - is rEh' <br />e <br />-- ( <br />p � Lt _SLJ <br />L--( -- S — if- .?D <br />� PU ' GT k <br />- Z <br />P la.� SE <br />- Z ,s- 9 <br />It <br />'•i- PO - g7•; <br />Sampler(s) (signature) <br />Field ID <br />0 --I� „ <br />Relinquished by: (signature) <br />Received b : (signature) <br />Date/Time <br />Comments <br />h- t C'e'tav� <br />Sealed for shipment by: (signature) <r <br />Comments: " <br />Dalelrime <br />Shipment method: <br />Recelving ,Laboratory: Please return original form after signing for receipt of samples. <br />C <br />