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S' ' L D & D Management Consultants, Inc.- <br /> 6440 Hesket Court <br /> CHAIN OF CUSTODY RECORD San Jose, CA 95123 . <br /> PP10:ECT NO. SITE NANIE&ADDRESS p <br /> r _ N-\ ANAL YSES REQUESTEDk i <br /> .Vff !+F--- u' Af- i 17`'i INSPECTC�s NAME i i3 � � °1 <br /> ° �I REMARK <br /> : - 0 a) n <br /> 76 <br /> t 'Rx <br /> T 5 <br /> iia. NO. i CATS � � SAMPLING LCCr�TiON � �� —°� >- � <br /> x. <br /> 1 j ray±!�v 1 � O/zf�' � � /�• 5 � 7f � ,1'/ { / ! l t l <br /> y <br /> I ! 1 l 1V J�� •::,' / <br /> j <br /> Relinquished by- iJ1 .1:31i.irtf�2iEJ-i1.'+'c� i R$C51V?'J by, ;ti.Qiiai'Jr31 The fol1cSwing MUST Br c-omoleled IJV the lab-:-a.Y:J accepting 53ri'.'Jl�'5 <br /> I for anaiys!s- <br /> L i Have. oll sa-rnDles received for 2.rialysi-s be-n=i rrrl in ice' <br /> P tier: (S 7r•�,ura= � G�iet ane Rccf.ived by: !SiQr+a>vrp) �] <br /> 2. A ill sarnples4rernain refrigerated until analvzed? € <br /> 1 4 I <br /> Relinquished h —4 rn:rtrr?) —` Ua[erTi: e Received ':y: Oruro; 3. did any sant es received for analysis have hel=d space'? s <br /> I 9 !: (Si n <br /> I i WeiC sain ie: ir; pprcpii.W!ccr7la=rtPrs ;!nd uroporly;.rack: <br /> Rel !sh ci r'; irta ;aterrirnL i E _o'd to Laboratrry W..': {Sign.i✓ure) -- ---- - <br /> ' <br />