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4�- Joz (o <br /> ••.••...• SAMPLE f- D 1p Z L2 'X <br /> ...t:NLNT RECORD <br /> Generator/Client''/yl <br /> AEMC Project Manager_ <br /> Job Description JAI <br /> SAMPLING INrORMATION <br /> Sampling Date_O Q <br /> i ^ k � Sampling Collector_t�o[d.� -P .21Sampling Location <br /> (Provide sketch on ac an match ramp a with ram in <br /> P 4ocation <br /> i• Suspected Toxic Coastituents�n <br /> � 1P Field Coaditions�`��/�'- <br /> Sample , <br /> Depth/ <br /> i De th/ T;, eSam le. ;- Type S_ _ <br /> gum# Sampled Method _ <br /> �Not- <br /> es^ <br /> n <br /> '•) S j <br /> P01�mpr an 4 camp es, attach a Continuation Sheet LABORATORY ANALYSIS <br /> I • �� Contact/Phone 1 <br /> Date/Time Samples Delivered <br /> AEMC P.O.t <br /> Report Due Date `Rush' Authorized by.7 ,,,, <br /> Analysis Requested <br /> Send results to AEMC Laboratory, Attention: 't ,` <br /> Sample Retention Instructions <br /> . CHAIN OF CUSTODY <br /> Relinquished by (Company) Receivd b <br /> fJ� y (Company) Date/Time <br /> JMRIAd� <br /> CORP <br /> 11855 WhiteERocckNRo d, RanchoA <br /> ACor ova, CAT95670ORATION <br /> FORM 20-52 (916) 985-6666 <br /> 9 <br />