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,44ITSHAUSER0 <br /> corporation <br /> 7901 STONERIDGE OR SUITE 123 CHAIN O F CUSTODY RECORD <br /> PLEASANTQN CA 94596 <br /> (510)416 2900 <br /> PAGE _± OF <br /> PROJECT NUMBER PROJECT NAME / <br /> SAMPLED BY, (PRINTED AND SIGNATURE) s� <br /> zREMARKS <br /> � zVT' <br /> SAMPLE NUMBER DATE TIME TYPE SAMPLE LOCATION z U <br /> w¢t'f- 1 3 <br /> 1 ut& 3 X = <br /> C <br /> CHROMALAB FILE # 6 320 3 <br /> ORDER If <br /> I <br /> RELINQUISHED BY (SIGNATURE) DATE TIME RECEIVED BY SIGNATU TOTAL NO OF SAMPLES <br /> ' ( (THIS SWPUENT) LABORA/TOR�YJ <br /> (��� r /(O TOTAL OI' CONTAINER5 G !USI <br /> THISIS SHIPMENT) <br /> RELINQUISHED BY (SIGNATURE} DATE TIME REQ (SIGNATURE) LABORATORY CONTACT LABORATORY PHONE NUMBER <br /> �7-a Gook, (3 10) 93/ -17a;g <br /> RELINQUISHEDrSIGNATURE) DATE TIME RECEIVED FOP LABORATORY BY SAMPLE ANALYSIS REQUEST SHEET <br /> (SIGNATURE}�,-�- ATTACHED ( )YES 0()NO <br /> DISTRIBUTION WHITE, MITTELHAUSER CORPORATION REMARKSc /rte to ma�;p'e'e ���=f�1��11 d Ralfel'�( IV, -Vl <br /> CANARY, LABORATORY �1 1 <br /> PINK, CLIENT NO114M a/ fu/' W e�e4lyq[ <br /> GOLD, PROJECT FILE 1 1-1( #- _ 741 _ 0 >--- <br />