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CHAIN OF CUSTODY / ANALYSES REQUEST FORM <br /> Project No. : ! 3 Field Logbook No. : Date i L' Serial �NTo. ; <br /> Project Name- /� Project Location- 1Vo �2�2 <br /> Sampler (Signature) ` ANALYSES Samplers: <br /> SAMPLES <br /> SAMPLE N0. DATE TIME LAB SAMPLE O. OF SAMPLE AQP AQP �' REMARKS <br /> N . TAINERS TYRE Q <br /> IP ' z. 01`t 4 <br /> 2 d <br /> e0L <br /> T�t n,i {Ne <br /> � O <br /> 1P <br /> l <br /> *352 <br /> t e�l+5 <br /> M2 1 -P <br /> D I sa <br /> !i S <br /> A V <br /> RELINQUISHED BY: DATTIM RECEIVED BY: DATE TIME r, <br /> (Signature) ' J _ ! (Signature) <br /> RELINQUISHED BY: DTE TTmr RECEIVED BY: DATE TIME <br /> (Signature) (Signature) <br /> RELINQUISHED BY: DATE TIME RECEIVED BY: DATE TIME <br /> (Signature) (Signature) <br /> METHOD OF SHIPMENT: DATE TIME LAB COMMENTS: <br /> Sample Collector: LEVINE-FRICKE Analytical Laboratory: <br /> 1900 Powell Street. 121h Floor 0 <br /> Emeryville,Co 94608 �c <br /> (415)652-4500 <br /> Shipping Copy (white) Lab Copy (Green) Fie Copy (Yellow) Field Copy (Pink) FORM NO. 86/COC/ARF <br /> • --.,;,..,ter »,...` - -- — - --- ---�„r� <br />