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CHAIN OF CUSTODY / ANALYSES REQUEST FORM 5'� <br /> Project No. ' Field Logbook S'90 // a7 <br /> Date* <br /> Serial No. <br /> Project Name: z N? 422$ <br /> Project Location: �C1C. <br /> Sampler (Signature) <br /> SAMPLES <br /> ANALYSES Samplers: <br /> 01 tiu � 04 J� ' <br /> SAMPLE NO. DATE TIME LAB SAMPLE NO. OF SAMPLE �gP� �cQP� �� t4p <br /> NO. TAINERS TYPE R MARKS <br /> 7 L ►► x <br /> o \,b <br /> w `S w7o l <br /> Gv5- S 7 <br /> oO 0q A s, <br /> s� 66 ItA <br /> lCr <br /> RELINQUISHED BY: DATME RECEIVED B <br /> (Signature} 013 (Signator DA� rT)ME <br /> RELINQUISHED BY: AT � <br /> (Signature) TIME RECEIVED BY: <br /> (Signature) D TE TIME <br /> RELINQUISHED BY: ME RECEIVED BY: <br /> (Signature) DATE TIME <br /> METhOD OF SHIPMENT: (Signature) <br /> DATE TIME <br /> DATE LAB COMMENTS: <br /> Sample Collector: LEVINE-FRICKE Analytical Laboratory: t"rwr 3 LS <br /> 1900 Powell Street, 12th Floor It-*-� S oCS6 <br /> Emeryville,Co 94608 �� 5) 3.0 � 0 r7 3�1 SIU V�C `r <br /> (415}452-4500 <br /> Shipping (White) Lab Copy (Green) File Copy (Yellow) fd Copy (Pink) <br /> rn�y ,v. ac irnr•._� <br />