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Dale: <br /> Page Qf <br /> Chain-of Custody Record - <br /> Project No.: 7 i ANALYSES REMARKS <br /> Additional Comments <br /> Samplers(Signature:) o �, o <br /> D ❑ d L'} ❑ 7 <br /> cif N T N C4 r' N T � = L <br /> m <br /> .7 m m ps q C l 1E E 41 <br /> — O(0 4 p - <br /> ED`c� 0 m o r- m c`)i m¢ v n C7 _ m � �r' + <br /> ern 2a t L <br /> Date Time Sample Number ars a s a' a <br /> w w= wm w wI wm M n /I <br /> IN L <br /> L <br /> .'v <br /> i - � i u <br /> Laboratory: Turnaround Time: Results to- <br /> rr l rias-'}• j°e.+ Total No. of Containers <br /> Date: Relin wished by {Signature): Date' Method o1 Shipment: <br /> a <br /> Relinquished b [Signature): Date: inquished by {Signature): q <br /> Prt ed Name: Printed Mama: Printed Name: Time; Laboratory Comments and Log No.: <br /> Time: Time: <br /> Company: Company: Company: <br /> ecei�ed b rye. Date: by: ❑ t Received hy: <br /> Date: <br /> P inted Name: Time: printed Narne: <br /> P ted Name Time: F/ Ctieumasrrix Coetaulxer�k3 <br /> A/J Time: <br /> - �' 21st well se er Slreel, 121h FsoGr Oa kfand,Gk 94(312 <br /> Company: Lt,4> Company Company: ph 51G-663-4100 Fat:514.663.4141 <br />