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Sample Chain-of-Custody/Analysis Request <br />Pam 2-1 <br />Kennedy/Jenks Consultants <br />Hazards <br />fJ15 F•iJ taY�( qh f <br />„Ii: ��� �: (.tt�.'.�'�q�:l�:.t��i.`K�.f Leh <br />10"!Mt <br />r' <br />.ti!�✓�/ i�� �' �w�L�� <br />��n%� <br />Client Reportto <br />�� <br />All MO,'„1 :Mi,:— , 73M <br />_1111 <br />Destinationossiblo <br />Lab <br />V <br />Site <br />Project No. Company----- <br />♦ <br />Address <br />Sampler Name ------ <br />Telephone <br />s`�is{.'>w� <br />WHO <br />■©■ <br />BE <br />NN <br />Mm i!MMM aii'iREM <br />I■■ <br />�lm, ia1 ivo, Elmo ■i�■■■IMMIN <br />Ii0■11M ■■■e� <br />■■ <br />1■0■1M M <br />■®■INIMME <br />■■■■■ <br />goo. -Elm <br />i■©■ <br />11110live-similomno <br />no <br />Elm <br />(1) Write only one sample number In each space. (4) Preservatlonofsample. <br />(2) Specify type of sample(s): Water (W), Solid (S), or indicate type. (5) Write each analysis requested across tap. Place an "X' in appropriate column to <br />(3) Mark each sample which should be composhed in Laboratory as follows: Place an "A" in box for each sample that should be composited into one sample; use sequential letter for additional groups. Indicate type of analysis needed for each sample. <br />r � i W" fG��'Y`T' <br />�5f �1, S�•.r �4:A�fi��"_3'sf.�Pffi,%� �4 <br />fJ15 F•iJ taY�( qh f <br />„Ii: ��� �: (.tt�.'.�'�q�:l�:.t��i.`K�.f Leh <br />gy:; <br />.ti!�✓�/ i�� �' �w�L�� <br />��n%� <br />" ., ,%71,1. A <br />�� <br />All MO,'„1 :Mi,:— , 73M <br />no <br />Kennedy/Jenks Consultants, Inc. © 2001 <br />