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�3 - <br /> 1 _ Page ' o ' <br /> - <br /> Environmental Laboratory <br /> 8880 Interchange Drive Analysis Request and Chain of Custody Recor <br /> Houston, Texas 77054 <br /> 713/660-0901 <br /> Project No _-- Client/Project Name Project Location <br /> _ Field = Date a a Sample Sample Preser- LABORATORY <br /> Sample No/ and o Container Type(Liquid ANALYSIS REQUESTED REMARKS <br /> - Identification_ Time a U (Size/Mat'l) Sludge Etc) vatnre <br /> mg, �3&1 90 15-109 <br /> �Qo <br /> Samplers_(Sign ure) all uished Date 1`yr �¢ Received by Date Intact <br /> _ (Sign ture) !Z ] (Signature <br /> - Time ()zI Time <br /> Relinq ished by Date Received by Date Intact <br /> -- _ (Srgrta re} {Signature} <br /> -Affiliation <br /> Time Time <br /> _ — Relinquished by Date Received by DateInla <br /> (Signature) (Signature) 2 <br /> Time Time } C <br /> SAMPLER REMARKSReceiv or labo tory Date �_�_g Laboratory No <br /> _ (51g ure) iFy- Time r 3i <br /> Seal* -v D Rewits � " <br />