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� r <br /> N <br /> HELL SIL COMPANY CHAIN OF CUSTODY RECORD �t -I9�9z <br /> _ RETAIL ENVIRONMENTAL ENGINEERING _ WESTScnal No Pant: / ufe, <br /> Soc Address Analysis Required LAB: <br /> CHECK ONE(1)BOX ONLY CT/DT TURN AROUND TIMF <br /> shell Engineer <br /> Pbate No a/G Quarterly Monitoring �546I 24 hours <br /> A/7� j�� — Fen N <br /> t< S-lL'�1o8 Site Investtgstton i 5441 48 haws i <br /> �� L/ —------ -. _. __ _ _- _ Sal far dtspnsal 5442 IS days rlune+.11 <br /> Gmsultant Name A Addr ��r � � r � Water far disposal i3-71I <br /> odw <br /> -� Au Sampk-Sys O&M [ 5452 <br /> C4msullant Contact- Dhow Nom/3�v� r��" � NOTE. Nally Lab as <br /> Fax 11• �� --,3341/ 00 <br /> Water Sampk Sys OdtM ] 54331 u possible o( <br /> Comments , G� ' �4 ell o +� Otha [ 241411 Itss TAT - <br /> tnto N z <br /> a� 4 ` �"81 <br /> SAMPLE <br /> Q Q 4n MATERIAL <br /> S`n'p�By .+ G CRIPTION CONDITION/ <br /> 9/� DESCOMMENTS <br /> Pruticd Name 1-1 �� — -- _ <br /> Sod Water Mr Ido Of pp,�, pq > <br /> Sampk ID <br /> Dole <br /> conis F-� <br /> JC -c <br /> i <br /> X <br /> lgr7a <br /> d ut $ { afore) - - -- -- Printed name ---- - - palet-`� R - - -sign T •j- -` -— - ed IA <br /> e- IT <br /> Ua1e <br /> imyutshed By (signature) Pruned name• Date Recewed(sttnaturo) Printed nrnts Date_ <br /> 'film Time <br /> Relinquished Ry (signature) Printed name a stew ga <br /> (statme) Rutted name �e - <br /> .f, [rime <br /> , <br /> TIIE L.ABCRATORY MUST PROVIDE A COPY OF THIS CHAIN-OF-CUSTODY WITH INVOICE AND RESULTS i <br /> 1 a+1 RLv6mfMt I}a1c 11yISN1 <br />