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3229 cou T N° 0916 <br /> Du Pont Environmental Remediation Services <br /> CHAIN-OF-CUSTODY RECORD <br />' 7068 Koll Center Parkway, Suite 401, Pleasanton, California 94566, (510) 462-7772 <br /> Testing Laborato <br /> r Phone Number <br /> Address VA3 ` r- l/ <br />' <br /> City, State Zip <br /> r 01 PURCHASE ORDER NO <br />' PROJECTNAME- ANALYSIS <br /> SITE LOCATION <br /> JOB NUMBER. - 3 1 D" O <br /> REQUESTOR <br /> SAMPLER'S SIGNATURE <br /> i <br /> SAMYl.E LUTE TTML'' COMP CRAB Lt7GT1t5NS NO Of SAMPLE �'-M'IRKs <br /> ID CONTAINERS TYPE <br />' RELINQUISHED BY (Signature) DATE RECEIVED BY (Signature) DATE <br /> .6- 7- 1 TIME TIME <br /> REPRESENTING �; Qd REPRESENTING <br /> RELINQUISHED BY (Signature) DATE RECEIVED BY (Signature) DATE <br />' REPRESENTING TIME REPRESENTING TIME <br /> RELINQUISHED BY (Signature) DATE R(E�CEIVED BY (Signature) DAT <br /> TIMETI <br /> REPRESENTING REPRESENTING + <br />' METHOD OF SHIPMENT ► c — L-e J f l � I <br /> y� cit , f E7o dM k. <br /> ` <br /> Wllrr'E Return to Clicnt with Report YELLOW LaboratoryCopy PINK.Originator's Copy �� <br />