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Chain of Custody Record <br /> COC No.: <br /> • <br /> Science Applications <br /> international Corporation Date: �3 Page t of_ <br /> ® An Employee Owned Company <br /> * � Requested Parameters <br /> Name. ��� • -NLaboratory Name <br /> VP, �° 1A P 5�"� - LS—S <br /> Address 'b ,� <br /> `11L�� ,�.. o�-� ... � Address <br /> Phone Number po <br /> t �y <br /> Project Manager �► �'.�- �- Tk <br /> • , R0 A D <br /> Project Name "� Contact <br /> Job/P.O. No. <br /> � <br /> Sampl r attire) Printed Name) , UI <br /> OBSERVATIONS,COMMENTS <br /> Date Time Matrix SPECIAL INSTRUCTIONS <br /> Laboratory o. <br /> Site ID laid Sample# S1te.Type Depth <br /> Atzah <br /> .•.•.•.'..•. IS7 r k <br /> 4)-2 t;(o.) 13 <br /> 5 J <br /> ............ <br /> _2Z <br /> T-F� r <br /> .. ........... -3y �o b 6�o <br /> 9p,1SP <br /> ........... <br /> , Al <br /> mac--f �, =S 1 b b V J 3 <br /> ... VK S 3 <br /> 5:'97 <br /> C.�K� 3 <br /> •lin•uis Date Received:by;: flag:• Total Number of Containers: <br /> Re q Y Notes: Shipment Method: <br /> • •. 6AM Poe 'PAT, <br /> Airbill No.: <br /> 12,'L®3 � : <br /> Signature <br /> : i�,latur�• 1 t� Z-O b j Custody Seal 1 No.. <br /> ` T"' T, <br /> Custody Seal 2 No.. <br /> ; • 1e <br /> TIS:•'•' Field COC No.s: <br /> I l ]t� , <br /> Printed Name <br /> t?rin3ed:Narrie: <br /> :C0 •'•• SAIC Location <br /> ...... <br /> tc <br /> Sacramento <br /> Com. .............. <br /> Company <br /> _ �Pa�: 3800 Watt Avenue <br /> Relinquished by <br /> Date lie '•ei�:hy• ._ hate:• Sacramento,CA 95821 <br /> ' tel. 916-974-8800 <br /> 1 <br /> �.r�:-:•''':•'''•: fax 916-974-8830 <br /> 10A %* <br /> �� '•' Project Manager: <br /> Signature i attire. •. <br /> s4 'Time <br /> G P��t��: tee. . <br /> Printed Name ,•, <br /> c'>A i C, <br /> ':- <br /> . .......... .... <br /> ...... <br /> ..... <br /> Company .;.;.:._....•.•..•:. .......... ........ <br /> Science A lications International Corporation White.. <br /> Laboratory Pink:Project Manager Yellow:Field Project Manager <br /> PP <br /> 0.1 <br />