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iA <br /> Chain of Custody Record �--1 <br /> 4 P <br /> Science Applications COC No.: <br /> International Corporation D 2-- <br /> ate: 10b,3 03 Page—of 3 <br /> An Employee Owned Company <br /> Namely-L- Requesd Parameters W z T Laboratory Name <br /> Address --SS�O W -"Ave- LL 210 -5-Ac+0,64 q5sz <br /> Phone Number <br /> r� Address <br /> Project Manager 'roPiD Pe L- F-0-47`�- <br /> Project Name -- 1k-ACY 91.0-0A) P-0-Al) M <br /> Job/P.O. No. 06. <br /> Contact <br /> p fSign ture) (Printed Name., ::z <br /> IV-0 k, <br /> i 'Z' <z OBSERVATIONS,COMMENTS <br /> Laboratory No. Site ID Field Sampled# Site Type Depth Date Time Matrix SPECIAL INSTRUCTIONS <br /> ............. <br /> 3 45 <br /> .............. <br /> ............. <br /> ............. <br /> .............. <br /> ............. <br /> 1v13/0 .:5"` ,0 f <br /> ............. <br /> ............. <br /> ............. <br /> ............. <br /> ............. <br /> ............. <br /> ............. <br /> ............. <br /> X XC <br /> .............. <br /> ............. <br /> NJ <br /> C L/K:-rRrL '13 <br /> ............. <br /> ............. <br /> ....... 17 <br /> axl pi-rZ <br /> f, ell <br /> 1-7 to 1011YI03 <br /> ............. <br /> A i4oLD Jm( <br /> ............. <br /> ..... �'� "1 'l�_ ���z /v 9�0 3 �C ,c i <br /> ............. <br /> UxTolz 10/2q/D3 <br /> ............ flbL.D <br /> ............. <br /> 55 5 X i4 0 LJ) <br /> KVK <br /> ............. <br /> ......................... C-VXrSS D <br /> ?P/ZY/D3ct:57S OL <br /> Relinq fished by A Date Received:tajr; flag: <br /> Total Number of Containers: <br /> ................ ... <br /> A <br /> Now Shipment Method: <br /> ........................................................................... .... <br /> ........................................... <br /> 03 ....................................... ....... Airbill No.: <br /> Signature ......... ..... <br /> .............. <br /> ......................... <br /> .................................... Custody Seal 1 No.: <br /> ...... ...... ... <br /> ......... <br /> Custody Seal 2 No.: <br /> .............. ............... <br /> Time ...... . <br /> ................ .............. Field COC No.s: <br /> Printed Name .............................. <br /> ............... . .. <br /> "V ..................................... <br /> ...... <br /> SAIL Location <br /> ................... ........... <br /> toman Sacramento <br /> ............................ <br /> 3800 Watt Avenue <br /> . ........... <br /> ....................... <br /> Relinquished by Date ....... <br /> ......... Sacramento,CA 95821 <br /> - - <br /> ........ . tel. 916-974-8800 <br /> Signature fax 9169748830 <br /> .......... Project Manager: <br /> Time <br /> ............ <br /> Printed Name 1:Printed,Name,.,. ........ <br /> ............. <br /> .......................................... <br /> ............... <br /> ........................................ ....... <br /> .... ........ <br /> ....................... <br /> ..................... ........... <br /> ................................. <br /> .... ..................... ........... <br /> .... ................................. <br /> ..................... ...... <br /> ............ <br /> Company X.Owiany.. <br /> Science Applications International Corporation White:Laboratory Pink.Project Manager Yellow.Field Project Manager <br />