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The Twining Laboratories, Inc. <br /> CHAIN OF CUSTODY RECORD <br /> Project No. 77- 686 -00 570 SToc-TG�,J <br /> Date/Time Sampled /- P - 8 C- <br /> Affiliation of Sampler/Shipper XWC r eaa,0-//v14Nrrr 7-L <br /> Address 75'7,7 Jy 64 9il7 /a Z,9 Z67s —7L <br /> Number Street City State Zip Telephone <br /> Collector's Name X5V/l <br /> Signature <br /> Transported By Date Shipped <br /> Sample Receiver TL <br /> Address .fpivrF. <br /> Date/Time Received <br /> Comments <br /> Collector's <br /> Sample No. Sample Description Analysis Requested <br /> or/ 7c- -, <br /> v✓a r7�l or / Tc.. .�. Tva/y PL/S a. l a q vt +S L <br /> Z P,2�/�,/ .. v�, /,i 2' err c/f��..�., tu' <br /> Chainof�ssio <br /> Signature Affiliatjon Inclusive <br /> Dates <br /> 2. ItzzAju <br /> SignaZW7�1&4 <br /> Affiliation Inclusive Dates <br /> 3. /-9-4-7 <br /> -7 <br /> /f Signature Affiliation Inclusive Dates <br /> 4. <br /> Signature Affiliation Inclusive Dates <br />