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_ <br /> t 500 Giuseppe Court,Suite 3 ( ; <br /> 1�xc 11A ft'1 Roseville,CA 95678 CH wd=OF-CUSTODY RECORD AND ANALYSIS REQUEST ` <br /> Environmental Labs h:916-773-3(364 Fx:916-773-4784 <br /> D Project Manager. Phone a:'¢ �5'-G/ <br /> ¢/ Electronic Data Delive/rrable uest: <br /> 7 �� Global i.D.0 l [� O oa/s9 Email Address: <br /> r � A S 3 S 3 COC <br /> Company/Address: Fax h. <br /> '9/6 Location I.Q.#: datl QS Al I/ u.lfhr.Co� <br /> a/,I a5 L./L � 3Sq^/ 7 ANALYSIS REQUEST PRse of <br /> Project Number/P.00: Project Name: m Wet 6inA,i <br /> /1 /0� M fir. 3 <br /> o a Total 2L Due Date: <br /> Project Location: G c h 6-tom �Q 7 r Ta <br /> 0 Sampler Sigr)ature: o � o %4 N <br /> sTbcic ^� <br /> CM <br /> N p <br /> S L <br /> Y W <br /> 0t7. C PIY6 51 �/ t^G- /4J jL a! l N cc m (,n c <br /> m � L7 N �i L <br /> r O � <br /> Sampling Container Method MatrixCD <br /> E a m t2 a k <br /> Preserved o m "' w o m Q C) v <br /> W m Ln m m N N o Z r <br /> Sam�"� N - 0 C N <br /> Nm d N m N U. <br /> ID Date Time U a MO o o °� N o = X U <br /> w � V) M w u X L rn Q a '+ <br /> O � 4 U z w o Q p °C m a- ¢ a m U b o m w m a d . m LAB USE <br /> r a = s v z to a m r r r o a LO m U U ONLY: <br /> w- r �E s:�s a X <br /> s' 1 K 30 <br /> D <br /> 7 <br /> D <br /> P <br /> n I LL I I I <br /> Relinquished by: Date Time Received by: Remarks/Condition of Sample: <br /> D <br /> rl <br /> 9 inquished by: bate Time Received by: . <br /> N <br /> T6 <br /> y <br /> 4 Relinquished by: Date Time Received by Laboratory: Bill To: <br />