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CHAIN OF CUSTODY RECOR.ND ANALYSIS REQUEST S HO i'/ C <br /> 5500 Boscell Common Fremont CA 94538 Tel 510 490-8571 Fax 510 490-8572 <br /> [?NS/TE Project Manager Gam►,)f Bill to <br /> E N V I R O N M E N T A L Client Name ' &&=Wo V R5 Cry,..-ez Company <br /> LABORATORIES, INC iAddress ZUZv / Iti0o dwA,-V <br /> s� Address <br /> City, State ZIP S' rtr! A,,. 04- 9.7 ;�-C City, State ZIP <br /> Phone 7 f Y &3 r ` •fs&L Phone <br /> Date W 4/7/�i'4 Fax 7/y 66 7 7t Y-4 Fax <br /> Page j of 09 <br /> Laboratory E H v Project Name .r/ r -. r P O No oc <br /> Lab Number 2 F o 16 Project Number -x d a g N61 mac, S r 'T <br /> Analysis Requested <br /> O � O <br /> T � <br /> fB NCr <br /> m O N <br /> a c w d U <br /> Sample Identification Date Sampled Time Sampled MatrixN a m a z Remarks <br /> IWW— - S 5- U 5- f/ :t; t`^y 2F04-01 X <br /> �v -1 3 5-'5' "- `4-/y 1/ 10 w // -, -/6 1 - as Ix3 <br /> ink/-13- -7 //5-0 W rzas -01. y <br /> 1P <br /> MW- 1 #16 4 12 Sy W r° 12 5.9 `oY X X <br /> fit'-1 -y[ YAovr r1., SL w 1.2 ' 1 0/ <br /> tit I/— <br /> `/ 3 �'✓ 3 1) o/� <br /> W-1�-66- q9 13 0 I-V /� o -os X X y 1 <br /> W-11-664"A ovr 3 '30 11V <br /> mW-8- Y17149 13 So w <br /> 1V-1y-66-Z(b,"' c Ap 1 350 <br /> iv-14 - & 99 kv / LU <br /> MW - Iti --43 - t `((�/�19 j'r• 2f W �,�o -a X x <br /> - i3 -w) "(PIgq rY 21; \N <br /> /4 11,11 rY- Er=g - 41'ril `� �� V,/ f� to - .�8 <br /> Initials Printed Name Signature Date Total Containers <br /> My Start Time Received Intact <br /> c1r �Rrl�f oStop Time Received Cold <br /> 10 Hours Custody Seals <br /> Client Sign-off <br /> Whitp Copv - Admin/1 ah Ypllow- Mohilp I ah Pink -Clipnt <br />